Organization
EAR, NOSE & THROAT PLASTIC SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NEIL ANTHONY PERSAUD D.O (OWNER)
(678) 838-3903
Entity
Organization
Contact information
Practice address
6130 PRESTLEY MILL RD STE C, DOUGLASVILLE, GA 30134-2288
(678) 838-3903
(678) 838-7454
Mailing address
6130 PRESTLEY MILL RD STE C, DOUGLASVILLE, GA 30134-2288
(678) 838-3903
(678) 838-7454
Taxonomy
Speciality
Code
Description
License number
State
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CH6392
RAILROAD MEDICARE
GA
Enumeration date
11/21/2006
Last updated
08/22/2020
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