NPIMap

Organization Active NPI

ENT of Athens, LLC

  • Sleep Medicine (Otolaryngology) Physician
  • Athens, GA
National Provider Identifier
1063746709
Registry record updated Jun 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sleep Medicine (Otolaryngology) PhysicianTaxonomy code 207YS0012X
License
052997 Issued in GA
Legal business name
ENT OF ATHENS, LLC
Practice address
150 Nacoochee Ave
Athens, GA 30601-1823
Phone
(706) 546-7908
Fax
(706) 546-1944
NPI assigned
Sep 29, 2009
Last updated
Jun 7, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2021

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

Authorized official

Name
Amy Ellis
Title
Billing Manager
Phone
(706) 546-7908

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sleep Medicine (Otolaryngology) Physician 207YS0012X 052997 GA Primary

Addresses

Primary practice location

150 Nacoochee Ave
Athens, GA 30601-1823

Mailing address

150 Nacoochee Ave
Athens, GA 30601-1823
Phone (706) 546-7908

Other identifiers 1

IdentifierTypeStateIssuer
446447978BMedicaidGA

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address cmixson@entofathens.gwaydirect.com
Direct Messaging Address cmixson@entofathens.gwaydirect.com

National Provider Directory

National Provider Directory

Interoperability endpoints

  • Direct secure messaging: cmixson@entofathens.gwaydirect.com

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1254182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623024000000",
    "number": "1063746709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 NACOOCHEE AVE",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306011823",
            "telephone_number": "706-546-7908",
            "fax_number": "706-546-1944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 NACOOCHEE AVE",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306011823",
            "telephone_number": "706-546-7908",
            "fax_number": "706-546-1944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENT OF ATHENS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-29",
        "last_updated": "2021-06-07",
        "certification_date": "2021-06-07",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "706-546-7908"
    },
    "taxonomies": [
        {
            "code": "207YS0012X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Sleep Medicine",
            "state": "GA",
            "license": "052997",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "446447978B",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cmixson@entofathens.gwaydirect.com",
            "affiliation": "N",
            "endpointDescription": "direct email",
            "address_1": "150 Nacoochee Ave",
            "city": "Athens",
            "state": "GA",
            "country_code": "US",
            "postal_code": "306011823",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cmixson@entofathens.gwaydirect.com",
            "affiliation": "N",
            "address_1": "150 Nacoochee Ave",
            "city": "Athens",
            "state": "GA",
            "country_code": "US",
            "postal_code": "306011823",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Athens, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2021; 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.