Basic Information
Provider Information | |||||||||
NPI: | 1013054568 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SYSKO | ||||||||
FirstName: | JOCELYN | ||||||||
MiddleName: | HOWARD | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | AU.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4380 GEORGETOWN SQ | ||||||||
Address2: | STE 1002 | ||||||||
City: | ATLANTA | ||||||||
State: | GA | ||||||||
PostalCode: | 303386254 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7702208400 | ||||||||
FaxNumber: | 7702349979 | ||||||||
Practice Location | |||||||||
Address1: | 830 EAGLES LANDING PKWY | ||||||||
Address2: | STE 102 | ||||||||
City: | STOCKBRIDGE | ||||||||
State: | GA | ||||||||
PostalCode: | 302817366 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7709912800 | ||||||||
FaxNumber: | 7709912801 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/31/2007 | ||||||||
LastUpdateDate: | 11/16/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AUD003753 | GA | Y |   | Speech, Language and Hearing Service Providers | Audiologist |   |
No ID Information.