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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
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