Provider Demographics
NPI:1548296296
Name:ENT SURGERY CENTER OF AUGUSTA, LLC
Entity type:Organization
Organization Name:ENT SURGERY CENTER OF AUGUSTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ELLIOTT
Authorized Official - Last Name:BARFIELD
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:706-364-4040
Mailing Address - Street 1:340 N BELAIR RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3000
Mailing Address - Country:US
Mailing Address - Phone:706-364-4040
Mailing Address - Fax:706-364-8402
Practice Address - Street 1:340 N BELAIR RD
Practice Address - Street 2:SUITE B
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3000
Practice Address - Country:US
Practice Address - Phone:706-364-4040
Practice Address - Fax:706-364-8402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036286261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA51003904002OtherBLUE CROSS OF GA PROVIDER
GA51003904002OtherBLUE CROSS OF GA PROVIDER
GAY29482Medicare UPIN