Provider Demographics
NPI:1558517466
Name:EAR, NOSE & THROAT ASSOCIATES OF SAVANNAH, P.C.
Entity Type:Organization
Organization Name:EAR, NOSE & THROAT ASSOCIATES OF SAVANNAH, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:912-629-4502
Mailing Address - Street 1:5201 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4501
Mailing Address - Country:US
Mailing Address - Phone:912-351-3030
Mailing Address - Fax:912-351-3039
Practice Address - Street 1:13040 ABERCORN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1955
Practice Address - Country:US
Practice Address - Phone:912-927-2848
Practice Address - Fax:912-351-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3593Medicare PIN