MEDICARE: ATLANTA ENT SINUS & ALLERGY ASSOCIATES PC

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	174400000X	Specialist	020005	GA

General Provider Information

NPI Number	:	1285619544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTA ENT SINUS & ALLERGY ASSOCIATES PC

Provider Business Mailing Address
First Line	:	5555 PEACHTREE DUNWOODY RD NE
Second Line	:	SUITE 125
City	:	ATLANTA
State	:	GA
Zip	:	30342-1703
Country	:	US
Telephone Number	:	404-255-2918
Fax Number	:	404-250-0162

Provider Business Practice Location Address
First Line	:	5555 PEACHTREE DUNWOODY RD NE
Second Line	:	SUITE 125
City	:	ATLANTA
State	:	GA
Zip	:	30342-1703
Country	:	US
Telephone Number	:	404-255-2918
Fax Number	:	404-255-5837

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. LEYLA FARMAN
Credential	:
Telephone Number	:	404-255-3510

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	07/31/2013

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