Organization
SOUTHERN CRESCENT ENT, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA JEAN ELLIOTT (PRACTICIE MANAGER)
(770) 474-7416
Entity
Organization
Contact information
Practice address
1101 HOSPITAL DR, SUITE 100A, STOCKBRIDGE, GA 30281-9075
(770) 474-7416
(770) 389-6210
Mailing address
1101 HOSPITAL DR, SUITE 100A, STOCKBRIDGE, GA 30281-9075
(770) 474-7416
(770) 389-6210
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
039722
GA
207YX0901X
Otology & Neurotology Physician
046956
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00677553A
—
GA
Enumeration date
11/03/2005
Last updated
11/14/2011
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