NPIMap

Organization Active NPI

Advanced Ear Nose and Throat Associates PC

  • Otolaryngology Physician
  • Atlanta, GA
National Provider Identifier
1073655882
Registry record updated Jan 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
657566 Issued in GA
Legal business name
ADVANCED EAR NOSE AND THROAT ASSOCIATES PC
Practice address
960 Johnson Ferry Rd NE
Suite 200
Atlanta, GA 30342-1631
Phone
(404) 943-0900
Fax
(404) 943-1390
NPI assigned
Feb 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2013

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

Authorized official

Name
Kelly Ladd
Title
Practice Manager
Phone
(404) 943-0900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Y00000X 657566 GA Primary

Addresses

Primary practice location

960 Johnson Ferry Rd NE
Suite 200
Atlanta, GA 30342-1631

Mailing address

960 Johnson Ferry Rd NE
Suite 200
Atlanta, GA 30342-1631
Phone (404) 943-0900

Other identifiers 1

IdentifierTypeStateIssuer
CH9705OtherGARAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050202000598 GA Part B Supplier - Clinic/Group Practice 2860443322 Receives reassigned benefits from 8 practitioners
Practice locations: Atlanta, GA

National Provider Directory

National Provider Directory

Locations

960 Johnson Fy Rd NE
Ste 200
Sandy Springs, GA 30342
Phone (404) 943-0090

Practitioners & affiliated clinicians

Practitioners 8

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": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358121600000",
    "number": "1073655882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 JOHNSON FERRY RD NE",
            "address_2": "SUITE 200",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421631",
            "telephone_number": "404-943-0900",
            "fax_number": "404-943-1390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 JOHNSON FERRY RD NE",
            "address_2": "SUITE 200",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421631",
            "telephone_number": "404-943-0900",
            "fax_number": "404-943-1390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED EAR NOSE AND THROAT ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2013-01-14",
        "status": "A",
        "authorized_official_last_name": "LADD",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "404-943-0900"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": "GA",
            "license": "657566",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CH9705",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.