Provider Demographics
NPI:1679333611
Name:MIDDLE GEORGIA AUDIOLOGY LLC
Entity type:Organization
Organization Name:MIDDLE GEORGIA AUDIOLOGY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:PETERSON
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:478-235-5836
Mailing Address - Street 1:524 S HOUSTON LAKE RD STE E100
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-9059
Mailing Address - Country:US
Mailing Address - Phone:478-235-5836
Mailing Address - Fax:478-239-5146
Practice Address - Street 1:524 S HOUSTON LAKE RD STE E100
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-9059
Practice Address - Country:US
Practice Address - Phone:478-235-5836
Practice Address - Fax:478-239-5146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty