Provider Demographics
NPI:1629086327
Name:EAR, NOSE, THROAT, AND ALLERGY ASSOCIATES OF SOUTH GEORGIA PC
Entity Type:Organization
Organization Name:EAR, NOSE, THROAT, AND ALLERGY ASSOCIATES OF SOUTH GEORGIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:VANN
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-244-2562
Mailing Address - Street 1:2910 N PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1720
Mailing Address - Country:US
Mailing Address - Phone:229-244-2562
Mailing Address - Fax:229-249-0000
Practice Address - Street 1:2910 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1720
Practice Address - Country:US
Practice Address - Phone:229-244-2562
Practice Address - Fax:229-249-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP1090Medicare ID - Type Unspecified