MEDICARE: EAR,NOSE,& THROAT OF NORTHWEST GEORGIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	12408	GA

General Provider Information

NPI Number	:	1114986163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAR,NOSE,& THROAT OF NORTHWEST GEORGIA

Provider Business Mailing Address
First Line	:	107 JOHN MADDOX DR NW
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30165-1419
Country	:	US
Telephone Number	:	706-235-5533
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 JOHN MADDOX DR NW
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30165-1419
Country	:	US
Telephone Number	:	706-235-7008
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RAYMOND HOWARD
Credential	:	M.D.
Telephone Number	:	706-235-0116

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	01/20/2022

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Directions to “EAR,NOSE,& THROAT OF NORTHWEST GEORGIA ” Practice Location

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