Healthcare Provider Details

I. General information

NPI: 1245305879
Provider Name (Legal Business Name): PIEDMONT EAR NOSE &THROAT ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 PEACHTREE STREET SUITE 200
ATLANTA GA
30309-1605
US

IV. Provider business mailing address

1720 PEACHTREE STREET SUITE 200
ATLANTA GA
30309-1605
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-5045
  • Fax: 404-351-0883
Mailing address:
  • Phone: 404-351-5045
  • Fax: 404-351-0883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. TATIANA SYCHEVA-JOHNSON
Title or Position: BILLING MANAGER
Credential:
Phone: 470-563-6468