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General NPI Number Information
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NPI Number | 1447381116
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Entity Type | Organization
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Legal Business Name | ATLANTA KIDS ENT, PC
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 02/24/2012
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Provider Practice Location Address
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Address Line | 2550 WINDY HILL RD SE SUITE 307
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City | MARIETTA
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State | GA
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Zip | 30067-8665
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Country | US
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Telephone | 770-953-1414
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Fax | 770-953-9474
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Provider Business Mailing Address
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Address Line | 2550 WINDY HILL RD SE SUITE 307
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City | MARIETTA
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State | GA
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Zip | 30067-8665
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Country | US
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Telephone | 770-953-1414
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Fax | 770-953-9474
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Authorized Official
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Title or Position | PRESIDENT
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Name | DEBORAH M BURTON
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Credential | MD
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Telephone | 770-953-1414
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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 | 039297
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License Number State | GA
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