Provider Demographics
NPI:1073569281
Name:EAR, NOSE & THROAT GROUP, INC
Entity Type:Organization
Organization Name:EAR, NOSE & THROAT GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-761-1220
Mailing Address - Street 1:5625 POPLAR AVE.
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3815
Mailing Address - Country:US
Mailing Address - Phone:901-761-1220
Mailing Address - Fax:901-763-4332
Practice Address - Street 1:5625 POPLAR AVE.
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3815
Practice Address - Country:US
Practice Address - Phone:901-761-1220
Practice Address - Fax:901-761-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000003815174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty