Provider Demographics
NPI:1912169590
Name:HEARING DIAGNOSTICS AND SOLUTIONS
Entity type:Organization
Organization Name:HEARING DIAGNOSTICS AND SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:DADE
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:706-587-8289
Mailing Address - Street 1:1157 LEAF BROOK DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31820-5515
Mailing Address - Country:US
Mailing Address - Phone:706-604-5332
Mailing Address - Fax:706-565-4647
Practice Address - Street 1:4215 WOODRUFF RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6889
Practice Address - Country:US
Practice Address - Phone:706-604-5332
Practice Address - Fax:706-565-4647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003725237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA628850698AMedicaid
GA64BCBRBMedicare PIN