Organization
ACTIVEAR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORISSA MILLER (OWNER)
(229) 506-3451
Entity
Organization
Contact information
Practice address
200 S HOUSTON LAKE RD, WARNER ROBINS, GA 31088-9006
(478) 922-4327
(229) 245-1020
Mailing address
2935 N ASHLEY ST STE 101, VALDOSTA, GA 31602-1786
(229) 506-3451
(229) 245-1020
Taxonomy
Speciality
Code
Description
License number
State
332S00000X
Hearing Aid Equipment
Primary
HADE035128
GA
Other
Enumeration date
11/14/2016
Last updated
11/06/2023
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