Healthcare Provider Details

I. General information

NPI: 1932330495
Provider Name (Legal Business Name): ESTHER XIMENA VIVAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2009
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EMORY UNIVERSITY HOSPITAL 1364 CLIFTON ROAD, NE
ATLANTA GA
30322-0001
US

IV. Provider business mailing address

EMORY UNIVERSITY HOSPITAL 1364 CLIFTON ROAD, NE
ATLANTA GA
30322-0001
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-8035
  • Fax:
Mailing address:
  • Phone: 718-920-4267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number249257
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number69995
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: