Organization
ENT OF ATHENS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMY ELLIS (INSURANCE CLERK)
(706) 546-7908
Entity
Organization
Contact information
Practice address
150 NACOOCHEE AVE, ATHENS, GA 30601-1823
(706) 546-7908
(706) 546-0918
Mailing address
150 NACOOCHEE AVE, ATHENS, GA 30601-1823
(706) 546-7908
(706) 546-0918
Taxonomy
Speciality
Code
Description
License number
State
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
12368
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000135902A
—
GA
05
—
000135924A
—
GA
01
—
581198425
INDIVIDUAL TAX ID
GA
01
—
581440304
INDIVIDUAL TAX ID
GA
Enumeration date
01/02/2007
Last updated
06/18/2012
Update your record
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