Provider Demographics
NPI:1376932327
Name:ERDMAN ENT, PC
Entity Type:Organization
Organization Name:ERDMAN ENT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:ERDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-861-7070
Mailing Address - Street 1:140 BATTLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FORT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-4006
Mailing Address - Country:US
Mailing Address - Phone:706-861-7070
Mailing Address - Fax:706-861-7050
Practice Address - Street 1:140 BATTLEWOOD DR
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-4006
Practice Address - Country:US
Practice Address - Phone:706-861-7070
Practice Address - Fax:706-861-7050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA35251207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE64901Medicare UPIN