Southern Otologic Clinic PC

Primary specialty

Otology & Neurotology PhysicianTaxonomy code 207YX0901X

License

24465 Issued in GA

Legal business name

SOUTHERN OTOLOGIC CLINIC PC

Practice address

818 Saint Sebastian Way
Suite 204
Augusta, GA 30901-2651

Phone

(706) 724-0668

Fax

(706) 724-1124

NPI assigned

Jun 28, 2006

Last updated

Aug 4, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. William Henry Moretz Jr., M.D.NPI 1013942291

Title

President

Phone

(706) 724-0668

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 2

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.

• William H Moretz, MD

  • Otology & Neurotology Physician
  • Augusta, GA
  • NPI 1013942291
  Medicare reassignment NPD Authorized official
• Brandi Nicole Pettis, AU.D.

  • Audiologist
  • Augusta, GA
  • NPI 1235301771
  NPD (past)

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217808000000",
    "number": "1184651523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "818 SAINT SEBASTIAN WAY",
            "address_2": "SUITE 204",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309012651",
            "telephone_number": "706-724-0668",
            "fax_number": "706-724-1124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "818 SAINT SEBASTIAN WAY",
            "address_2": "SUITE 204",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309012651",
            "telephone_number": "706-724-0668",
            "fax_number": "706-724-1124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN OTOLOGIC CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-28",
        "last_updated": "2008-08-04",
        "status": "A",
        "authorized_official_last_name": "MORETZ",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "HENRY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "706-724-0668",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207YX0901X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otology & Neurotology",
            "state": "GA",
            "license": "24465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Southern Home Care Services, Inc.
• Southern Internal Medicine Critical Care Associates, LLC
• Southern Oral Surgery & Implant Specialists PC
• John C. Sowell, DDS
• Melanie A Spann
• Lakeisha Michele Sparks, NP
• Preston Jeremy Sparks, DO
• Shea Sparks

• Otology & Neurotology Physician in Augusta, GA
• Providers in Augusta, GA by specialty
• Otology & Neurotology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2008; 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.