Provider Demographics
NPI:1609671387
Name:RENOE, GERALD S (HADS001148)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:S
Last Name:RENOE
Suffix:
Gender:
Credentials:HADS001148
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 N EXPRESSWAY # 127
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-1753
Mailing Address - Country:US
Mailing Address - Phone:470-204-1829
Mailing Address - Fax:
Practice Address - Street 1:1424 N EXPRESSWAY # 127
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-1753
Practice Address - Country:US
Practice Address - Phone:470-204-1829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADS001148237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist