Organization
JKP BALANCE & HEARING CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TYSHA MOANA POWELL AU.D. (AUDIOLOGIST)
(404) 484-6305
Entity
Organization
Contact information
Practice address
465 WINN WAY, SUITE 231, DECATUR, GA 30030-1753
(404) 484-6305
Mailing address
1270 CAROLINE ST NE, SUITE D120-355, ATLANTA, GA 30307-2758
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
AUD003621
GA
Other
Enumeration date
03/05/2008
Last updated
03/05/2008
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