Provider Demographics
NPI:1730273400
Name:GEORGIA ENT & FACIAL PLASTICS, P.C.
Entity type:Organization
Organization Name:GEORGIA ENT & FACIAL PLASTICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:229-244-9944
Mailing Address - Street 1:2418 N OAK ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2575
Mailing Address - Country:US
Mailing Address - Phone:229-244-9944
Mailing Address - Fax:229-244-9942
Practice Address - Street 1:2418 N OAK ST
Practice Address - Street 2:SUITE G
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2575
Practice Address - Country:US
Practice Address - Phone:229-244-9944
Practice Address - Fax:229-244-9942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA482753103DMedicaid
GA482753103DMedicaid
GAGRP7860Medicare ID - Type Unspecified