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Organization
NORTHWEST ENT ASSOCIATES, PC
Active
Organization
NORTHWEST ENT ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARLOS M. EGEA (ADMINISTRATOR)
(770) 427-0368
Entity
Organization
Contact information
Practice address
80 LACY ST NW, MARIETTA, GA 30060
(770) 427-0368
(678) 581-5969
Mailing address
80 LACY ST NW, MARIETTA, GA 30060
(770) 427-0368
(678) 581-5969
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
31970
GA
207Y00000X
Otolaryngology Physician
36884
GA
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
041239
GA
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
—
NULL
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
—
—
Other
Enumeration date
11/02/2006
Last updated
09/28/2012
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