Provider Demographics
NPI:1407017437
Name:ENT OF ATLANTA LLC
Entity Type:Organization
Organization Name:ENT OF ATLANTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:PABLO
Authorized Official - Last Name:STOLOVITZKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-220-8400
Mailing Address - Street 1:4380 GEORGETOWN SQ
Mailing Address - Street 2:STE 1002
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6254
Mailing Address - Country:US
Mailing Address - Phone:770-220-8400
Mailing Address - Fax:770-234-9979
Practice Address - Street 1:4380 GEORGETOWN SQ
Practice Address - Street 2:STE 1002
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6254
Practice Address - Country:US
Practice Address - Phone:770-220-8400
Practice Address - Fax:770-234-9979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty