Basic Information
| Provider Information | |||||||||
| NPI: | 1679979470 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SURRIDGE | ||||||||
| FirstName: | CORY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | AU.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 741 KENILWORTH AVE | ||||||||
| Address2: | SUITE100 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282042933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045238021 | ||||||||
| FaxNumber: | 7045238031 | ||||||||
| Practice Location | |||||||||
| Address1: | 741 KENILWORTH AVE | ||||||||
| Address2: | SUITE100 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282042933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045238021 | ||||||||
| FaxNumber: | 7045238031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2014 | ||||||||
| LastUpdateDate: | 11/06/2014 | ||||||||
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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 | 231H00000X | 10994 | NC | Y | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | 10994 | NC | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.