Provider Demographics
NPI:1992734644
Name:EAR NOSE AND THROAT ASSOCIATES PC
Entity type:Organization
Organization Name:EAR NOSE AND THROAT ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:ZAJONC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-929-9101
Mailing Address - Street 1:2340 KNOB CREEK RD STE 704
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2977
Mailing Address - Country:US
Mailing Address - Phone:423-929-9101
Mailing Address - Fax:423-434-2032
Practice Address - Street 1:2340 KNOB CREEK RD STE 704
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2977
Practice Address - Country:US
Practice Address - Phone:423-929-9101
Practice Address - Fax:423-434-2032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNCA7519OtherRAILROAD MEDICARE
TN3373581Medicare ID - Type Unspecified