Provider Demographics
NPI:1972655215
Name:ENT SURGICAL ASSOCIATES OF CENTRAL GA, PC
Entity type:Organization
Organization Name:ENT SURGICAL ASSOCIATES OF CENTRAL GA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALAIN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:TOLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DO,
Authorized Official - Phone:478-923-0106
Mailing Address - Street 1:1719 RUSSELL PKWY
Mailing Address - Street 2:BLDG 300, STE 301
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-5763
Mailing Address - Country:US
Mailing Address - Phone:478-923-0106
Mailing Address - Fax:478-922-5211
Practice Address - Street 1:1719 RUSSELL PKWY
Practice Address - Street 2:BLDG 300, STE 301
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-5763
Practice Address - Country:US
Practice Address - Phone:478-923-0106
Practice Address - Fax:478-922-5211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP24Medicare ID - Type UnspecifiedGROUP PROVIDER ID