Southeast ENT & Facial Plastic Surgeyr, PC

Primary specialty

Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X

License

035071 Issued in GA

Legal business name

SOUTHEAST ENT & FACIAL PLASTIC SURGEYR, PC

Practice address

1000 Towne Center Blvd
Suite 501
Pooler, GA 31322-4052

Phone

(912) 330-5030

Fax

(912) 330-5033

NPI assigned

Sep 1, 2011

Last updated

Sep 1, 2011By 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. Robert E Johnson, M.D.

Title

Owner

Phone

(912) 330-5030

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1314835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314835200000",
    "number": "1912288135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 TOWNE CENTER BLVD",
            "address_2": "SUITE 501",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313224052",
            "telephone_number": "912-330-5030",
            "fax_number": "912-330-5033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 TOWNE CENTER BLVD",
            "address_2": "SUITE 501",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313224052",
            "telephone_number": "912-330-5030",
            "fax_number": "912-330-5033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST ENT & FACIAL PLASTIC SURGEYR, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-01",
        "last_updated": "2011-09-01",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-330-5030",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207YX0905X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "GA",
            "license": "035071",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Otolaryngology/Facial Plastic Surgery Physician in Pooler, GA
• Providers in Pooler, GA by specialty
• Otolaryngology/Facial Plastic Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 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.