Healthcare Provider Details

I. General information

NPI: 1144476110
Provider Name (Legal Business Name): EAR, NOSE & THROAT ASSOCIATES OF SAVANNAH, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 09/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 CANAL STREET BUILDING 100 SUITE 102
POOLER GA
31322
US

IV. Provider business mailing address

5201 FREDERICK STREET
SAVANNAH GA
31405-4501
US

V. Phone/Fax

Practice location:
  • Phone: 912-351-3030
  • Fax: 912-351-3039
Mailing address:
  • Phone: 912-351-3030
  • Fax: 912-351-3039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: FRED DANIEL
Title or Position: MD
Credential: MD
Phone: 912-351-3030