Basic Information
| Provider Information | |||||||||
| NPI: | 1124319173 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCOGGINS | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | HAD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8800 SE SUNNYSIDE RD | ||||||||
| Address2: | STE. 300-N | ||||||||
| City: | CLACKAMAS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036595115 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4 COOSAWATTEE AVE SW | ||||||||
| Address2: | |||||||||
| City: | ROME | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301653500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062912496 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2011 | ||||||||
| LastUpdateDate: | 04/26/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | HADSOD0283 | GA | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.