Provider Demographics
NPI:1225044852
Name:ENT AND VOICE CARE OF ATLANTA, INC
Entity Type:Organization
Organization Name:ENT AND VOICE CARE OF ATLANTA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:V
Authorized Official - Last Name:LESLIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-939-7707
Mailing Address - Street 1:PO BOX 33457
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-0457
Mailing Address - Country:US
Mailing Address - Phone:770-939-7707
Mailing Address - Fax:770-939-7706
Practice Address - Street 1:1390 MONTREAL RD
Practice Address - Street 2:STE 120
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-8143
Practice Address - Country:US
Practice Address - Phone:770-939-7707
Practice Address - Fax:770-939-7706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048947207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000869492FMedicaid
GA04BDCPBMedicare ID - Type Unspecified
GA000869492FMedicaid