Basic Information
| Provider Information | |||||||||
| NPI: | 1639576853 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | TERRY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5119 OAK FIELD CT | ||||||||
| Address2: | |||||||||
| City: | MURRAYVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305641935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705330379 | ||||||||
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| Practice Location | |||||||||
| Address1: | 552 S ENOTA DR NE | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305018948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705363286 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2014 | ||||||||
| LastUpdateDate: | 06/17/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 762 | GA | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.