Healthcare Provider Details

I. General information

NPI: 1427151687
Provider Name (Legal Business Name): EAR, NOSE AND THROAT SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 WELLBROOK CIR NE
CONYERS GA
30012-3872
US

IV. Provider business mailing address

1370 WELLBROOK CIR NE
CONYERS GA
30012-3872
US

V. Phone/Fax

Practice location:
  • Phone: 770-922-5458
  • Fax: 678-750-0988
Mailing address:
  • Phone: 770-922-5458
  • Fax: 770-922-0435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANNELLE HUFFMAN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 770-712-2297