Provider Demographics
NPI:1689818312
Name:PIEDMONT EAR NOSE & THROAT ASSOCIATES
Entity Type:Organization
Organization Name:PIEDMONT EAR NOSE & THROAT ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-351-5045
Mailing Address - Street 1:1720 PEACHTREE ST NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2449
Mailing Address - Country:US
Mailing Address - Phone:404-351-5045
Mailing Address - Fax:404-897-7078
Practice Address - Street 1:5445 MERIDIAN MARKS RD NE
Practice Address - Street 2:SUITE 125
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4763
Practice Address - Country:US
Practice Address - Phone:404-351-5045
Practice Address - Fax:404-897-7078
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIEDMONT EAR NOSE & THROAT ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-24
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP861Medicare PIN