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General NPI Number Information
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NPI Number | 1144349614
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Entity Type | Organization
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Legal Business Name | PEACHTREE EAR, NOSE & THROAT CENTER, LLC
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1776 PEACHTREE ST NW NORTH TOWER, SUITE 260
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City | ATLANTA
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State | GA
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Zip | 30309-2307
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Country | US
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Telephone | 404-591-9100
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Fax | 404-591-9101
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Provider Business Mailing Address
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Address Line | 1776 PEACHTREE ST NW NORTH TOWER, SUITE 260
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City | ATLANTA
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State | GA
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Zip | 30309-2307
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Country | US
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Telephone | 404-591-9100
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Fax | 404-591-9101
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELAINA F GEORGE
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Credential | MD
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Telephone | 404-591-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 044724
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License Number State | GA
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