Provider Demographics
NPI:1144349614
Name:PEACHTREE EAR, NOSE & THROAT CENTER, LLC
Entity type:Organization
Organization Name:PEACHTREE EAR, NOSE & THROAT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELAINA
Authorized Official - Middle Name:F
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-591-9100
Mailing Address - Street 1:1776 PEACHTREE ST NW
Mailing Address - Street 2:NORTH TOWER, SUITE 260
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2307
Mailing Address - Country:US
Mailing Address - Phone:404-591-9100
Mailing Address - Fax:404-591-9101
Practice Address - Street 1:1776 PEACHTREE ST NW
Practice Address - Street 2:NORTH TOWER, SUITE 260
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2307
Practice Address - Country:US
Practice Address - Phone:404-591-9100
Practice Address - Fax:404-591-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044724174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG71138Medicare UPIN