Provider Demographics
NPI:1073834743
Name:BARROW GWINNETT EAR NOSE THROAT & SINUS, INC
Entity Type:Organization
Organization Name:BARROW GWINNETT EAR NOSE THROAT & SINUS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUOC
Authorized Official - Middle Name:U
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-931-2133
Mailing Address - Street 1:20 SATELLITE DR
Mailing Address - Street 2:STE 300
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-6211
Mailing Address - Country:US
Mailing Address - Phone:404-931-2133
Mailing Address - Fax:
Practice Address - Street 1:20 SATELLITE DR
Practice Address - Street 2:STE 300
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-6211
Practice Address - Country:US
Practice Address - Phone:404-931-2133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA64013207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty