# SOUTHEAST ENT & FACIAL PLASTIC SURGEYR, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912288135
- **Authorized official:** DR. ROBERT E JOHNSON M.D. (OWNER)
- **Authorized official phone:** (912) 330-5030

## Contact information

- **Practice address:** 1000 TOWNE CENTER BLVD, SUITE 501, POOLER, GA 31322-4052
- **Practice address phone:** (912) 330-5030
- **Practice address fax:** (912) 330-5033
- **Mailing address:** 1000 TOWNE CENTER BLVD, SUITE 501, POOLER, GA 31322-4052
- **Mailing address phone:** (912) 330-5030
- **Mailing address fax:** (912) 330-5033

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YX0905X | Otolaryngology/Facial Plastic Surgery Physician | 035071 | GA | Yes |

## Other

- **Enumeration date:** 09/01/2011
- **Last updated:** 09/01/2011