Provider Demographics
NPI:1861586901
Name:NORTHEAST GEORGIA ENT-HEAD & NECK SURGERY PC
Entity type:Organization
Organization Name:NORTHEAST GEORGIA ENT-HEAD & NECK SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-546-0144
Mailing Address - Street 1:700 SUNSET DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606
Mailing Address - Country:US
Mailing Address - Phone:706-546-0144
Mailing Address - Fax:706-543-9203
Practice Address - Street 1:700 SUNSET DR
Practice Address - Street 2:SUITE 103
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606
Practice Address - Country:US
Practice Address - Phone:706-546-0144
Practice Address - Fax:706-543-9203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G700337Medicare PIN