Provider Demographics
NPI:1609036144
Name:KUNKES EAR NOSE & THROAT PC
Entity Type:Organization
Organization Name:KUNKES EAR NOSE & THROAT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:PIA
Authorized Official - Middle Name:MAGDALENE
Authorized Official - Last Name:BERKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:698-902-0222
Mailing Address - Street 1:86 UPPER RIVERDALE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274
Mailing Address - Country:US
Mailing Address - Phone:678-902-0222
Mailing Address - Fax:
Practice Address - Street 1:86 UPPER RIVERDALE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274
Practice Address - Country:US
Practice Address - Phone:678-902-0222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021535207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty