Provider Demographics
NPI:1760434427
Name:DALTON EAR NOSE & THROAT ASSOCIATES
Entity Type:Organization
Organization Name:DALTON EAR NOSE & THROAT ASSOCIATES
Other - Org Name:FILTER... NORTHWEST GEORGIA ENT SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:TRAMMELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:706-226-2142
Mailing Address - Street 1:1436 CHATTANOOGA AVE
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2637
Mailing Address - Country:US
Mailing Address - Phone:706-226-2142
Mailing Address - Fax:706-272-3997
Practice Address - Street 1:1436 CHATTANOOGA AVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2637
Practice Address - Country:US
Practice Address - Phone:706-226-2142
Practice Address - Fax:706-272-3997
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DALTON EAR NOSE & THROAT ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-17
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADHR 20020475261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11-C0001207OtherDHR ASC ID NUMBER
GA055000432AOtherDHR LICENSE #
GA000970802AMedicaid