Healthcare Provider Details

I. General information

NPI: 1730273400
Provider Name (Legal Business Name): GEORGIA ENT & FACIAL PLASTICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2418 N OAK ST SUITE G
VALDOSTA GA
31602-2575
US

IV. Provider business mailing address

2418 N OAK ST SUITE G
VALDOSTA GA
31602-2575
US

V. Phone/Fax

Practice location:
  • Phone: 229-244-9944
  • Fax: 229-244-9942
Mailing address:
  • Phone: 229-244-9944
  • Fax: 229-244-9942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ARTHUR HARRY ALLEN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 229-244-9944