Organization
ENT OF SOUTH GEORGIA SURGERY CENTER LLC
Active
Parent organization
EAR, NOSE, THROAT AND ALLERGY ASSOCIATES OF SOUTH GEORGIA PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
EAR, NOSE, THROAT AND ALLERGY ASSOCIATES OF SOUTH GEORGIA PC
Authorized official
DR. RONALD V ALLEN (PRESIDENT)
(229) 244-2562
Entity
Organization
Contact information
Practice address
2805 N OAK ST, VALDOSTA, GA 31602-5922
(229) 244-2562
(229) 249-0000
Mailing address
2805 N OAK ST, VALDOSTA, GA 31602-5922
(229) 244-2562
(229) 249-0000
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000655146A
—
GA
05
—
000834589A
—
GA
05
—
000946668A
—
GA
Enumeration date
05/12/2016
Last updated
05/03/2017
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