Healthcare Provider Details

I. General information

NPI: 1326233388
Provider Name (Legal Business Name): ENT AND FACIAL PLASTIC SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3193 HOWELL MILL RD NW SUITE 215
ATLANTA GA
30327-2119
US

IV. Provider business mailing address

3193 HOWELL MILL RD NW SUITE 215
ATLANTA GA
30327-2119
US

V. Phone/Fax

Practice location:
  • Phone: 404-355-1312
  • Fax: 404-352-2798
Mailing address:
  • Phone: 404-355-1312
  • Fax: 404-352-2798

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: VALERIE GARRETT
Title or Position: OFFICE MANAGER
Credential:
Phone: 404-355-1312