Provider Demographics
NPI:1316084122
Name:GEORGIA EAR ASSOCIATES PC
Entity type:Organization
Organization Name:GEORGIA EAR ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANNING
Authorized Official - Middle Name:MILES
Authorized Official - Last Name:GOLDSMITH
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:912-350-5000
Mailing Address - Street 1:PO BOX 3720
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31414-3720
Mailing Address - Country:US
Mailing Address - Phone:912-350-5000
Mailing Address - Fax:912-350-5083
Practice Address - Street 1:4700 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6220
Practice Address - Country:US
Practice Address - Phone:912-350-5000
Practice Address - Fax:912-350-5083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025161174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL04BDCNHMedicare ID - Type Unspecified
FLC87475Medicare UPIN