NPIMap

Organization Active NPI

Ear, Nose and Throat Clinic of Coffee Co.

  • Specialist
  • Douglas, GA
National Provider Identifier
1891750774
Registry record updated Feb 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
041953 Issued in GA
Legal business name
EAR, NOSE AND THROAT CLINIC OF COFFEE CO.
Practice address
312 Westside Drive
Douglas, GA 31533-0312
Phone
(912) 384-2200
Fax
(912) 383-7992
NPI assigned
Apr 20, 2006
Last updated
Feb 4, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2010

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

Authorized official

Name
Mrs. Amber Patterson
Title
Office Manager
Phone
(912) 384-2200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 041953 GA Primary

Addresses

Primary practice location

312 Westside Drive
Douglas, GA 31533-0312

Mailing address

P.O. Box 1068
Douglas, GA 31533-1068
Phone (912) 384-2200

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050620000687 GA Part B Supplier - Clinic/Group Practice 4486698578 Receives reassigned benefits from 16 practitioners
Practice locations: Douglas, GA; Waycross, GA; Tifton, GA

National Provider Directory

National Provider Directory

Locations

310 Shirley Ave
Douglas, GA 31533
Phone (912) 260-3650

1703 Boulevard Sq
Waycross, GA 31501

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265241600000",
    "number": "1891750774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 1068",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315331068",
            "telephone_number": "912-384-2200",
            "fax_number": "912-383-7992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 WESTSIDE DRIVE",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315330312",
            "telephone_number": "912-384-2200",
            "fax_number": "912-383-7992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAR, NOSE AND THROAT CLINIC OF COFFEE CO.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-20",
        "last_updated": "2010-02-04",
        "status": "A",
        "authorized_official_last_name": "PATTERSON",
        "authorized_official_first_name": "AMBER",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "912-384-2200",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "GA",
            "license": "041953",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Douglas, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2010; 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.