Organization
EAR NOSE THROAT AND AUDIOLOGY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEROY BROADNAX (OFFICE MANAGER)
(704) 544-6533
Entity
Organization
Contact information
Practice address
327 W SOUTH ST, UNION, SC 29379-2838
(864) 429-0115
(864) 429-0271
Mailing address
8318 PINEVILLE MATTHEWS RD, SUITE 708-151, CHARLOTTE, NC 28226-4753
(704) 544-6533
(704) 544-6583
Taxonomy
Speciality
Code
Description
License number
State
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4146
—
SC
Enumeration date
01/09/2009
Last updated
01/09/2009
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