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Contact Information

SOUTHERN CRESCENT ENT, P.C.
1101 HOSPITAL DR
SUITE 100A
STOCKBRIDGE, GA30281-9075
 Phone: 770-474-7416
 Fax: 770-389-6210
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Otolaryngology

207Y00000X 04 Physician/Otolaryngology
 

Otology & Neurotology

207YX0901X 04 Physician/Otolaryngology
Indicates primary specialty

NPI Profile & details for SOUTHERN CRESCENT ENT, P.C.

NPI # 1841281391
LBN Legal business name SOUTHERN CRESCENT ENT, P.C.
Authorized official MELISSA ELLIOTT - (PRACTICIE MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 11/03/2005
Last updated 11/14/2011 - About 15 years ago
Identifiers
GA License # 039722
GA License # 046956
GA Medicaid 00677553A
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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