Provider Demographics
NPI:1194836254
Name:NORTHEAST ATLANTA EAR NOSE & THROAT, PC
Entity Type:Organization
Organization Name:NORTHEAST ATLANTA EAR NOSE & THROAT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-939-9614
Mailing Address - Street 1:3915 JOHNS CREEK COURT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024
Mailing Address - Country:US
Mailing Address - Phone:770-623-1608
Mailing Address - Fax:678-992-2540
Practice Address - Street 1:3915 JOHNS CREEK COURT
Practice Address - Street 2:SUITE 100
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024
Practice Address - Country:US
Practice Address - Phone:770-237-3000
Practice Address - Fax:678-992-2536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA055001197AMedicaid
GA055001197AMedicaid
GRP633Medicare PIN