Provider Demographics
NPI:1841445780
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:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-629-4535
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 1:16741 HIGHWAY 67 SOUTH
Practice Address - Street 2:SUITE G
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458
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:2008-11-19
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008102 B 621111207Y00000X
207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300034510AOtherMEDICAID PAYEE: SITE 1
GA300034510KOtherMEDICAID PAYEE: SITE 2
GA300034510KOtherMEDICAID PAYEE: SITE 2