Provider Demographics
NPI:1396927216
Name:ENT OF CHEROKEE
Entity type:Organization
Organization Name:ENT OF CHEROKEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SLAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-720-0838
Mailing Address - Street 1:100 MEDICAL LN
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2492
Mailing Address - Country:US
Mailing Address - Phone:770-720-0838
Mailing Address - Fax:
Practice Address - Street 1:100 MEDICAL LN
Practice Address - Street 2:SUITE 4
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2492
Practice Address - Country:US
Practice Address - Phone:770-720-0838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052632174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty