Healthcare Provider Details

I. General information

NPI: 1760434427
Provider Name (Legal Business Name): DALTON EAR NOSE & THROAT ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1436 CHATTANOOGA AVE
DALTON GA
30720-2637
US

IV. Provider business mailing address

1436 CHATTANOOGA AVE
DALTON GA
30720-2637
US

V. Phone/Fax

Practice location:
  • Phone: 706-226-2142
  • Fax: 706-272-3997
Mailing address:
  • Phone: 706-226-2142
  • Fax: 706-272-3997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberDHR 20020475
License Number StateGA

VIII. Authorized Official

Name: MR. DAVID L TRAMMELL
Title or Position: ASC DIRECTOR
Credential: RN
Phone: 706-226-2142