Provider Demographics
NPI:1962540898
Name:EAR, NOSE & THROAT ASSOCIATES, PC
Entity type:Organization
Organization Name:EAR, NOSE & THROAT ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PREDISENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-985-6233
Mailing Address - Street 1:1700 TREE LANE ROAD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078
Mailing Address - Country:US
Mailing Address - Phone:770-985-6233
Mailing Address - Fax:770-985-6864
Practice Address - Street 1:1700 TREE LN
Practice Address - Street 2:SUITE 320
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6782
Practice Address - Country:US
Practice Address - Phone:770-985-6233
Practice Address - Fax:770-985-6864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030076174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP5032Medicare PIN