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General NPI Number Information
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NPI Number | 1225044852
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Entity Type | Organization
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Legal Business Name | ENT AND VOICE CARE OF ATLANTA, INC
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 11/28/2007
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Provider Practice Location Address
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Address Line | 1390 MONTREAL RD STE 120
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City | TUCKER
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State | GA
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Zip | 30084-8143
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Country | US
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Telephone | 770-939-7707
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Fax | 770-939-7706
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Provider Business Mailing Address
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Address Line | PO BOX 33457
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City | DECATUR
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State | GA
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Zip | 30033-0457
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Country | US
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Telephone | 770-939-7707
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Fax | 770-939-7706
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | YVETTE V LESLIE
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Credential | M.D.
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Telephone | 770-939-7707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 048947
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License Number State | GA
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