Healthcare Provider Details

I. General information

NPI: 1194836254
Provider Name (Legal Business Name): NORTHEAST ATLANTA EAR NOSE & THROAT, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 JOHNS CREEK COURT SUITE 100
SUWANEE GA
30024
US

IV. Provider business mailing address

3915 JOHNS CREEK COURT SUITE 100
SUWANEE GA
30024
US

V. Phone/Fax

Practice location:
  • Phone: 770-237-3000
  • Fax: 678-992-2536
Mailing address:
  • Phone: 770-623-1608
  • Fax: 678-992-2540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: NINA FISCHBACH
Title or Position: CEO
Credential:
Phone: 770-939-9614