Ear Nose and Throat Facial Plastics and Sleep Disorder Ascllc

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

EAR NOSE AND THROAT FACIAL PLASTICS AND SLEEP DISORDER ASCLLC

Practice address

601 Pryor St SW
Atlanta, GA 30312

Phone

(404) 350-9200

Fax

(404) 529-9092

NPI assigned

Apr 11, 2017

Organization subpart

No

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

Authorized official

Name

Booker Terry Seymour III, M.D.NPI 1821164500

Title

Owner

Phone

(404) 350-9200

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• EAR NOSE & THROAT FACIAL PLASTICS & SLEEP DISORDER CENTER ASC LLC Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Ambulatory surgical center certification: CCN 11C0001492

Legal name

ENT FACIAL PLASTICS & SLEEP DISORDER CTR ASC, LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Jan 22, 2019

Last certification

Dec 3, 2018

Ownership / control type

Proprietary

Facility address

601 Pryor Street SW
Atlanta, GA 30312

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

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

• Booker Terry Seymour III, MD

  • Otolaryngology/Facial Plastic Surgery Physician
  • Atlanta, GA
  • NPI 1821164500
  NPD Authorized official

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

{
    "created_epoch": "1491868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533859200000",
    "number": "1679007108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 PRYOR ST SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303122719",
            "telephone_number": "404-350-9200",
            "fax_number": "404-529-9092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 PRYOR ST SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30312",
            "telephone_number": "404-350-9200",
            "fax_number": "404-529-9092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAR NOSE AND THROAT FACIAL PLASTICS AND SLEEP DISORDER ASCLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-11",
        "last_updated": "2018-08-10",
        "status": "A",
        "authorized_official_last_name": "SEYMOUR",
        "authorized_official_first_name": "BOOKER",
        "authorized_official_middle_name": "TERRY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-350-9200",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000663891A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1821164500",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EAR NOSE & THROAT FACIAL PLASTICS & SLEEP DISORDER CENTER ASC LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "EAR NOSE & THROAT FACIAL PLASTICS & SLEEP DISORDER CENTER ASC LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kelly-McKenzie Jameson Eakin, MD
• Peyton Ann Ealy
• Jesica M Eames, LCSW/JD
• Eamon Dutta, MD PC
• Ear Consultants of Georgia
• Ear Nose and Throat Facial Plastics PC
• Elizabeth Earhart, MS,LPC; MA,CCC-SLP
• Whitney Earhart
• Jordyn Earl
• Victoria Claire Earl, MD

• Ambulatory Surgical Clinic/Center in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Ambulatory Surgical Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.