Organization
ADVANCED EAR NOSE AND THROAT ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY LADD (PRACTICE MANAGER)
(404) 943-0900
Entity
Organization
Contact information
Practice address
960 JOHNSON FERRY RD NE, SUITE 200, ATLANTA, GA 30342-1631
(404) 943-0900
(404) 943-1390
Mailing address
960 JOHNSON FERRY RD NE, SUITE 200, ATLANTA, GA 30342-1631
(404) 943-0900
(404) 943-1390
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
657566
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CH9705
RAILROAD MEDICARE
GA
Enumeration date
02/12/2007
Last updated
01/14/2013
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