NPIMap

Organization Active NPI

ENT of Athens, LLC

  • Otolaryngology/Facial Plastic Surgery Physician
  • Athens, GA
National Provider Identifier
1598822280
Registry record updated Jun 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X
License
12368 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) 546-0918
NPI assigned
Jan 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2012

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

Authorized official

Name
Mrs. Amy Ellis
Title
Insurance Clerk
Phone
(706) 546-7908

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology/Facial Plastic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207YX0905X 12368 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 4

IdentifierTypeStateIssuer
581440304OtherGAINDIVIDUAL TAX ID
581198425OtherGAINDIVIDUAL TAX ID
000135902AMedicaidGA
000135924AMedicaidGA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080618000800 GA Part B Supplier - Clinic/Group Practice 8426129412 Receives reassigned benefits from 19 practitioners
Practice locations: Athens, GA

National Provider Directory

National Provider Directory

Locations

2142 W Broad St
Bldg 100
Athens, GA 30606
Phone (706) 548-6881

Practitioners & affiliated clinicians

Practitioners 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339977600000",
    "number": "1598822280",
    "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": "706-546-0918"
        },
        {
            "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": "706-546-0918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENT OF ATHENS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2012-06-18",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "INSURANCE CLERK",
        "authorized_official_telephone_number": "706-546-7908",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207YX0905X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "GA",
            "license": "12368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL TAX ID",
            "identifier": "581440304",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL TAX ID",
            "identifier": "581198425",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000135902A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000135924A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "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 18, 2012; 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.