Provider Demographics
NPI:1477506467
Name:STATESBORO ENT & SINUS CENTER
Entity Type:Organization
Organization Name:STATESBORO ENT & SINUS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINCOLN
Authorized Official - Middle Name:HAMMELL
Authorized Official - Last Name:LIPPINCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-681-7368
Mailing Address - Street 1:1497 FAIR RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0822
Mailing Address - Country:US
Mailing Address - Phone:912-681-7368
Mailing Address - Fax:912-681-3687
Practice Address - Street 1:1497 FAIR RD
Practice Address - Street 2:SUITE 205
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0822
Practice Address - Country:US
Practice Address - Phone:912-681-7368
Practice Address - Fax:912-681-3687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4487Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER