Organization
GRACE HEARING AND LANGUAGE SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICHELLE J WILSON AUD (AUDIOLOGIST/OWNER)
(762) 333-4400
Entity
Organization
Contact information
Practice address
3400 CHAPEL HILL RD, DOUGLASVILLE, GA 30135-1739
(678) 741-5310
Mailing address
3400 CHAPEL HILL RD, DOUGLASVILLE, GA 30135-1739
Taxonomy
Speciality
Code
Description
License number
State
261QH0700X
Hearing and Speech Clinic/Center
Primary
004014
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1730632290
NPPES INDIVIDUAL
GA
Enumeration date
08/12/2016
Last updated
08/12/2016
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