Provider Demographics
NPI:1134380017
Name:PEDIATRIC EAR, NOSE, & THROAT OF ATLANTA, PC
Entity type:Organization
Organization Name:PEDIATRIC EAR, NOSE, & THROAT OF ATLANTA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:THOMSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-255-2033
Mailing Address - Street 1:5461 MERIDIAN MARK ROAD SUITE 130
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1654
Mailing Address - Country:US
Mailing Address - Phone:404-255-2033
Mailing Address - Fax:404-252-1901
Practice Address - Street 1:5461 MERIDIAN MARK ROAD SUITE 130
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-255-2033
Practice Address - Fax:404-252-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric OtolaryngologyGroup - Single Specialty