Organization
THOMASTON EAR, NOSE AND THROAT INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN ANTHONY O'CONNELL MD (PHYSICIAN/PRESIDENT)
(706) 646-4508
Entity
Organization
Contact information
Practice address
210 CHEROKEE RD, THOMASTON, GA 30286-3402
(706) 646-4508
(706) 646-2752
Mailing address
210 CHEROKEE RD, THOMASTON, GA 30286-3402
(706) 646-4508
(706) 646-2752
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
041918
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00711301C
—
GA
01
—
040013774
RAIL ROAD MEDICARE
GA
01
—
584912
BLUE CROSS BLUE SHIELD
GA
Enumeration date
08/09/2005
Last updated
04/17/2008
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