Organization
EAR NOSE AND THROAT FACIAL PLASTICS AND SLEEP DISORDER ASCLLC
Active
Other names
EAR NOSE & THROAT FACIAL PLASTICS & SLEEP DISORDER CENTER ASC LLC
Organization subpart
No
Provider details
NPI number
Authorized official
BOOKER TERRY SEYMOUR III M.D. (OWNER)
(404) 350-9200
Entity
Organization
Contact information
Practice address
601 PRYOR ST SW, ATLANTA, GA 30312
(404) 350-9200
(404) 529-9092
Mailing address
601 PRYOR ST SW, ATLANTA, GA 30312-2719
(404) 350-9200
(404) 529-9092
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000663891A
—
GA
01
—
1821164500
INDIVIDUAL NPI
GA
Enumeration date
04/11/2017
Last updated
08/10/2018
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