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General NPI Number Information
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NPI Number | 1063746709
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Entity Type | Organization
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Legal Business Name | ENT OF ATHENS, LLC
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Dates
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Enumeration Date | 09/29/2009
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Last Update Date | 06/07/2021
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Provider Practice Location Address
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Address Line | 150 NACOOCHEE AVE
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City | ATHENS
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State | GA
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Zip | 30601-1823
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Country | US
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Telephone | 706-546-7908
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Fax | 706-546-1944
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Provider Business Mailing Address
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Address Line | 150 NACOOCHEE AVE
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City | ATHENS
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State | GA
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Zip | 30601-1823
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Country | US
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Telephone | 706-546-7908
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Fax | 706-546-1944
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | AMY ELLIS
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Credential |
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Telephone | 706-546-7908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0012X
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Taxonomy Name | Sleep Medicine (Otolaryngology) Physician
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License Number | 052997
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License Number State | GA
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