# ALLERGY AND ENT OF GA

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SOUTHERN HEALTH CORPORATION OF DAHLONEGA
- **Other names:** Allergy and ENT of GA
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1205919404
- **Legal business name:** SOUTHERN HEALTH CORPORATION OF DAHLONEGA
- **Authorized official:** MR. LARRY R JETER (CEO)
- **Authorized official phone:** (706) 867-4311

## Contact information

- **Practice address:** 227 MOUNTAIN DR, DAHLONEGA, GA 30533-1606
- **Practice address phone:** (706) 867-4306
- **Practice address fax:** (706) 864-1356
- **Mailing address:** PO BOX 1449, DAHLONEGA, GA 30533-0025
- **Mailing address phone:** (706) 864-1356
- **Mailing address fax:** (706) 864-1356

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 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