=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871760231
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATLANTA CHILDREN'S ENT, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2008
-----------------------------------------------------
Last Update Date | 05/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3400 OLD MILTON PKWY SUITE C-465
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30005-3707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-777-1100
-----------------------------------------------------
Fax | 770-751-9089
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3400 OLD MILTON PKWY SUITE C-465
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30005-3707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-777-1100
-----------------------------------------------------
Fax | 770-751-9089
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT AND OWNER
-----------------------------------------------------
Name | DR. ANN K WHITE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 770-777-1100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207YP0228X
-----------------------------------------------------
Taxonomy Name | Pediatric Otolaryngology Physician
-----------------------------------------------------
License Number | 035352
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------