Provider Demographics
NPI:1043686405
Name:WARNER, STAN (BC-HIS)
Entity type:Individual
Prefix:MR
First Name:STAN
Middle Name:
Last Name:WARNER
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W ACADEMY ST NW STE A
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-8524
Mailing Address - Country:US
Mailing Address - Phone:770-800-0041
Mailing Address - Fax:
Practice Address - Street 1:200 W ACADEMY ST NW STE A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-8524
Practice Address - Country:US
Practice Address - Phone:770-800-0041
Practice Address - Fax:888-859-3046
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADS000776237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist