Healthcare Provider Details
I. General information
NPI: 1902899628
Provider Name (Legal Business Name): ATLANTA INSTITUTE FOR ENT PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/29/2005
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:
III. Provider practice location address
5670 PEACHTREE DUNWOODY RD NE SUITE 1280
ATLANTA GA
30342-4792
US
IV. Provider business mailing address
5670 PEACHTREE DUNWOODY RD NE SUITE 1280
ATLANTA GA
30342-4792
US
V. Phone/Fax
- Phone: 404-257-1589
- Fax: 404-303-1950
- Phone: 404-257-1589
- Fax: 404-303-1950
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 174400000X |
| Taxonomy | Specialist |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207YP0228X |
| Taxonomy | Pediatric Otolaryngology Physician |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207YS0123X |
| Taxonomy | Facial Plastic Surgery Physician |
| License Number | |
| License Number State | |
| # 4 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207Y00000X |
| Taxonomy | Otolaryngology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
PRADEEP
KUMAR
SINHA
Title or Position: PRESIDENT
Credential: MD
Phone: 404-257-1589