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Organization
ALLERGY AND ENT OF GA
Active
Organization
ALLERGY AND ENT OF GA
Active
Parent organization
SOUTHERN HEALTH CORPORATION OF DAHLONEGA
Other names
Allergy and ENT of GA
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHERN HEALTH CORPORATION OF DAHLONEGA
Authorized official
MR. LARRY R JETER (CEO)
(706) 867-4311
Entity
Organization
Contact information
Practice address
227 MOUNTAIN DR, DAHLONEGA, GA 30533-1606
(706) 867-4306
(706) 864-1356
Mailing address
PO BOX 1449, DAHLONEGA, GA 30533-0025
(706) 864-1356
(706) 864-1356
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
Other
Enumeration date
10/23/2006
Last updated
06/30/2011
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