Provider Demographics
NPI:1770739740
Name:EAR, NOSE & THROAT ASSOCIATES OF SAVANNAH, PC
Entity type:Organization
Organization Name:EAR, NOSE & THROAT ASSOCIATES OF SAVANNAH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-351-3030
Mailing Address - Street 1:5201 FREDERICK STREET
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4501
Mailing Address - Country:US
Mailing Address - Phone:912-351-3030
Mailing Address - Fax:912-351-3039
Practice Address - Street 1:10164 FORD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3949
Practice Address - Country:US
Practice Address - Phone:912-351-3030
Practice Address - Fax:912-351-3039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3593Medicare PIN