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General NPI Number Information
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NPI Number | 1962540898
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Entity Type | Organization
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Legal Business Name | EAR, NOSE & THROAT ASSOCIATES, PC
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 11/26/2007
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Provider Practice Location Address
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Address Line | 1700 TREE LN SUITE 320
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City | SNELLVILLE
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State | GA
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Zip | 30078-6782
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Country | US
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Telephone | 770-985-6233
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Fax | 770-985-6864
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Provider Business Mailing Address
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Address Line | 1700 TREE LANE ROAD SUITE 320
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City | SNELLVILLE
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State | GA
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Zip | 30078
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Country | US
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Telephone | 770-985-6233
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Fax | 770-985-6864
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Authorized Official
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Title or Position | PREDISENT
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Name | NANCY R GRINER
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Credential | MD
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Telephone | 770-985-6233
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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 | 030076
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License Number State | GA
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