Provider Demographics
NPI:1972523215
Name:CHATTAHOOCHEE HEALTHCARE LLC
Entity Type:Organization
Organization Name:CHATTAHOOCHEE HEALTHCARE LLC
Other - Org Name:VILLA RICA EAR NOSE & THROAT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-459-0408
Mailing Address - Street 1:705 DALLAS HWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-1247
Mailing Address - Country:US
Mailing Address - Phone:770-459-0408
Mailing Address - Fax:770-459-1575
Practice Address - Street 1:705 DALLAS HWY
Practice Address - Street 2:SUITE 301
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-1247
Practice Address - Country:US
Practice Address - Phone:770-459-0408
Practice Address - Fax:770-459-1575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty