Healthcare Provider Details

I. General information

NPI: 1780183103
Provider Name (Legal Business Name): SOUTHERN ENT SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 02/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 NORTHSIDE CHEROKEE BLVD STE 410
CANTON GA
30115-8016
US

IV. Provider business mailing address

460 NORTHSIDE CHEROKEE BLVD STE 410
CANTON GA
30115-8016
US

V. Phone/Fax

Practice location:
  • Phone: 678-786-7430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES FRENCH JR.
Title or Position: OWNER
Credential: MD
Phone: 678-786-7430