Organization
NORTHWEST ENT ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARLOS M. EGEA (ADMINISTRATOR)
(770) 427-0368
Entity
Organization
Contact information
Practice address
80 LACY ST NW, MARIETTA, GA 30060
(770) 427-0368
(678) 581-5969
Mailing address
80 LACY ST NW, MARIETTA, GA 30060
(770) 427-0368
(678) 581-5969
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
31970
GA
207Y00000X
Otolaryngology Physician
36884
GA
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
041239
GA
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00403851E
—
GA
05
—
00553385C
—
GA
05
—
00868524B
—
GA
05
—
10041532
—
GA
05
—
303310
—
GA
05
—
310744
—
GA
05
—
310745
—
GA
05
—
582064647
—
GA
Enumeration date
11/02/2006
Last updated
09/28/2012
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