NPIMap

Organization Active NPI

Southern Crescent ENT, P.C.

  • Otolaryngology Physician
  • Stockbridge, GA
National Provider Identifier
1841281391
Registry record updated Nov 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
039722 Issued in GA
Legal business name
SOUTHERN CRESCENT ENT, P.C.
Practice address
1101 Hospital Dr
Suite 100a
Stockbridge, GA 30281-9075
Phone
(770) 474-7416
Fax
(770) 389-6210
NPI assigned
Nov 3, 2005
Last updated
Nov 14, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2011

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

Authorized official

Name
Melissa Jean Elliott
Title
Practicie Manager
Phone
(770) 474-7416

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 039722 GA Primary
Otology & Neurotology Physician 207YX0901X 046956 GA

Addresses

Primary practice location

1101 Hospital Dr
Suite 100a
Stockbridge, GA 30281-9075

Mailing address

1101 Hospital Dr
Suite 100a
Stockbridge, GA 30281-9075
Phone (770) 474-7416

Other identifiers 1

IdentifierTypeStateIssuer
00677553AMedicaidGA

National Provider Directory

National Provider Directory

Locations

1265 Highway 54 W
Ste 301
Fayetteville, GA 30214
Phone (678) 817-4390

1265 Highway 54 W
Ste 304
Fayetteville, GA 30214
Phone (678) 817-4390

616 S 8th St
#A
Griffin, GA 30224
Phone (770) 233-8570

1101 Hospital Dr
Ste 100A
Stockbridge, GA 30281
Phone (770) 474-7416

1129 Hospital Dr
#4D
Stockbridge, GA 30281
Phone (770) 474-7416

1129 Hospital Dr
Ste 4
Stockbridge, GA 30281
Phone (770) 474-7416

Practitioners & affiliated clinicians

Practitioners 7

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": "1130976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321228800000",
    "number": "1841281391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 HOSPITAL DR",
            "address_2": "SUITE 100A",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302819075",
            "telephone_number": "770-474-7416",
            "fax_number": "770-389-6210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 HOSPITAL DR",
            "address_2": "SUITE 100A",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302819075",
            "telephone_number": "770-474-7416",
            "fax_number": "770-389-6210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CRESCENT ENT, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-03",
        "last_updated": "2011-11-14",
        "status": "A",
        "authorized_official_last_name": "ELLIOTT",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "PRACTICIE MANAGER",
        "authorized_official_telephone_number": "770-474-7416"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "GA",
            "license": "039722",
            "primary": true
        },
        {
            "code": "207YX0901X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otology & Neurotology",
            "state": "GA",
            "license": "046956",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00677553A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockbridge, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2011; 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.