NPIMap

Organization Active NPI

Northside Ear, Nose & Throat, PC

  • Otolaryngology Physician
  • Roswell, GA
National Provider Identifier
1013071273
Registry record updated Sep 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
036368 Issued in GA
Legal business name
NORTHSIDE EAR, NOSE & THROAT, PC
Practice address
1360 Upper Hembree Rd
201
Roswell, GA 30076-1171
Phone
(770) 475-3361
Fax
(770) 664-4431
NPI assigned
Dec 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Andrew J Diamond, MD
Title
President
Phone
(770) 475-3361

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207K00000X 059383 GA
Otolaryngology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Y00000X 036368 GA Primary
Plastic Surgery within the Head & Neck (Otolaryngology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207YX0007X 57545 GA

Addresses

Primary practice location

1360 Upper Hembree Rd
201
Roswell, GA 30076-1171

Mailing address

PO Box 933087
Atlanta, GA 31193-3087
Phone (770) 475-3361

National Provider Directory

National Provider Directory

Locations

1360 Upper Hembree Rd
Ste 201
Roswell, GA 30076

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221091200000",
    "number": "1013071273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 933087",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311933087",
            "telephone_number": "770-475-3361",
            "fax_number": "770-664-4431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1360 UPPER HEMBREE RD",
            "address_2": "201",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300761171",
            "telephone_number": "770-475-3361",
            "fax_number": "770-664-4431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE EAR, NOSE & THROAT, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2008-09-11",
        "status": "A",
        "authorized_official_last_name": "DIAMOND",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-475-3361",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Allergy & Immunology",
            "state": "GA",
            "license": "059383",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "GA",
            "license": "036368",
            "primary": true
        },
        {
            "code": "207YX0007X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "GA",
            "license": "57545",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.