Healthcare Provider Details

I. General information

NPI: 1447309521
Provider Name (Legal Business Name): ALBANY EAR NOSE THROAT SINUS & ALLERGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 POINTE NORTH BLVD
ALBANY GA
31721-1514
US

IV. Provider business mailing address

605 POINTE NORTH BLVD
ALBANY GA
31721-1514
US

V. Phone/Fax

Practice location:
  • Phone: 229-435-7161
  • Fax: 229-438-8588
Mailing address:
  • Phone: 229-435-7161
  • Fax: 229-438-8588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LESLI W TODD
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 229-435-7161