Provider Demographics
NPI:1427823921
Name:MAGNOLIA HEARING CENTER
Entity type:Organization
Organization Name:MAGNOLIA HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEARING AID DISPENSER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SUDDERTH
Authorized Official - Suffix:
Authorized Official - Credentials:HADS
Authorized Official - Phone:706-870-3970
Mailing Address - Street 1:20 PAULA ST
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529-1626
Mailing Address - Country:US
Mailing Address - Phone:706-870-3970
Mailing Address - Fax:
Practice Address - Street 1:32 JOHNSON DR
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-2774
Practice Address - Country:US
Practice Address - Phone:770-853-9206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty