Provider Demographics
NPI:1265865232
Name:EAR, NOSE, THROAT, AND ALLERGY SPECIALISTS
Entity Type:Organization
Organization Name:EAR, NOSE, THROAT, AND ALLERGY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN TUYL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:770-345-6600
Mailing Address - Street 1:80A INTERSTATE SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-6226
Mailing Address - Country:US
Mailing Address - Phone:770-345-6600
Mailing Address - Fax:770-345-6611
Practice Address - Street 1:80A INTERSTATE SOUTH DR
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-6226
Practice Address - Country:US
Practice Address - Phone:770-345-6600
Practice Address - Fax:770-345-6611
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAR, NOSE, THROAT, AND ALLERGY SPECIALISTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA30684207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty