Healthcare Provider Details

I. General information

NPI: 1053463240
Provider Name (Legal Business Name): ENT,SINUS&ALLERGY SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 06/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

584 LANIER PARK DR
GAINESVILLE GA
30501-2000
US

IV. Provider business mailing address

584 LANIER PARK DR
GAINESVILLE GA
30501-2000
US

V. Phone/Fax

Practice location:
  • Phone: 770-354-5208
  • Fax: 770-534-8512
Mailing address:
  • Phone: 770-354-5208
  • Fax: 770-534-8512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RONALD N WHITMIRE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 770-534-5208