Provider Demographics
NPI:1184778425
Name:DUBLIN EAR NOSE AND THROAT ASSOCIATES, P.C.
Entity type:Organization
Organization Name:DUBLIN EAR NOSE AND THROAT ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ASBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-272-8382
Mailing Address - Street 1:102 FAIRVIEW PARK DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2500
Mailing Address - Country:US
Mailing Address - Phone:478-272-8382
Mailing Address - Fax:478-272-8464
Practice Address - Street 1:102 FAIRVIEW PARK DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2500
Practice Address - Country:US
Practice Address - Phone:478-272-8382
Practice Address - Fax:478-275-1964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00608924AMedicaid
GA00264569AMedicaid
GAD39707Medicare UPIN
GAF81379Medicare UPIN
GA00608924AMedicaid