EAR, NOSE, THROAT, AND ALLERGY ASSOCIATES OF SOUTH GEORGIA (NPI# 1629086327) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629086327 |
| Entity Type | Organization |
| Organization Name | EAR, NOSE, THROAT, AND ALLERGY ASSOCIATES OF SOUTH GEORGIA |
| Practice Address |
2910 N Patterson St Valdosta GA 31602-1720 |
| Practice Telephone | 2292442562 |
| Practice Fax Number | 2292490000 |
| Mailing Telephone | 2292442562 |
| Mailing Fax Number | 2292490000 |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. RONALD VANN ALLEN (PRESIDENT) |
| Authorized Official Telephone | 2292442562 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207YX0007X |
Otolaryngology Specialization: Plastic Surgery within the Head & Neck |
Allopathic & Osteopathic Physicians |
| Street Address |
2910 N PATTERSON ST |
| City | VALDOSTA |
| State | GA |
| Zip Code | 31602-1720 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528030806 | Theodore J Kanne | Otolaryngology | 2910 N Patterson St, Valdosta, GA 31602-1720 | 2006-02-02 |
| 1306252788 | Courtney D. Warren | Nurse Practitioner | 2910 N Patterson St, Valdosta, GA 31602-1720 | 2014-07-07 |
| 1194931345 | Virginia P Carroll | Audiologist-Hearing Aid Fitter | 2910 N Patterson St, Valdosta, GA 31602-1720 | 2007-05-15 |
| 1134247513 | Phillip Joseph Alt | Audiologist-Hearing Aid Fitter | 2910 N Patterson St, Valdosta, GA 31602-1720 | 2007-03-26 |
| 1831162049 | Ronald V Allen | Otolaryngology | 2910 N Patterson St, Valdosta, GA 31602-1720 | 2006-02-08 |
| 1033181318 | Thomas E Phillips | Otolaryngology | 2910 N Patterson St, Valdosta, GA 31602-1720 | 2006-02-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477198117 | Amber Michele Baugh | Behavior Technician | 2236 Bemiss Road, Valdosta, GA 31602 | 2019-11-15 |
| 1528611365 | Nishaben T. Patel | Nurse Practitioner | 3120 North Oak Street Extension, Suite B, Valdosta, GA 31602 | 2019-07-22 |
| 1427615871 | Blair Elizabeth Tomlinson | Nurse Practitioner | 2124 Lakeshore Drive, Valdosta, GA 31602 | 2019-05-21 |
| 1346704152 | Mildred Itaska Borowski | Counselor | 3790 North Highway 41, Suite A, Valdosta, GA 31602 | 2019-01-25 |
| 1962991703 | Southern Healthcare Alliance, LLC | Physical Medicine & Rehabilitation | 101-f W. Northside Drive, Valdosta, GA 31602 | 2018-05-08 |
| 1336636646 | Kaitlyn Thrift | Behavioral Analyst | 2225 Bemiss Road Suite D, Valdosta, GA 31602 | 2018-04-23 |
| 1407379845 | Lindsey Marie Richardson | Dentist | 103 W. Cranford Ave, Valdosta, GA 31602 | 2017-07-18 |
| 1962922427 | Taylor Nicole Fiveash | Nurse Practitioner | 101 W Northisde Dr, Bldg G, Valdosta, GA 31602 | 2017-06-26 |
| 1720520646 | Southern Sleepers Anesthesia LLC | Nurse Anesthetist, Certified Registered | 4120-b N. Valdosta Road, Valdosta, GA 31602 | 2016-11-09 |
| 1134670557 | Cataract and Laser Surgery Center of South Georgia, P.C. | Clinic/Center | 4120-b N. Valdosta Rd., Valdosta, GA 31602 | 2016-10-20 |
| Find all providers in zip 31602 | ||||
| Taxonomy Code | 207YX0007X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| Specialization | Plastic Surgery within the Head & Neck |
| An otolaryngologist with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery. The field is diverse and involves a wide age range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgeries are practiced, there are many additional procedures which interface with them. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy is currently provided in the subspecialty of Otolaryngology/Facial Plastic Surgery (see Taxonomy Code 207YX0905X) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033265798 | Aesthetic Solutions Center LLC | Otolaryngology | 5730 Glenridge Dr Ste T200, Sandy Springs, GA 30328-5873 | 2007-01-26 |
| 1639795529 | Savannah Stockton | Otolaryngology | 1120 15th St, Augusta, GA 30912-0004 | 2020-06-17 |
| 1689084022 | Marc Polacco | Otolaryngology | 902 Ponder Place Ct, Evans, GA 30809-3115 | 2014-05-07 |
| 1447698964 | Georgia Northside Ear, Nose and Throat, LLC | Otolaryngology | 1360 Upper Hembree Rd, Suite 201, Roswell, GA 30076-1171 | 2013-06-06 |
| 1649468463 | Joseph H. Berger, Md, LLC | Otolaryngology | 305 W Hansell St, Thomasville, GA 31792-6649 | 2007-10-05 |
| 1366553349 | Brian J Szwarc | Otolaryngology | 100 Mimosa Dr, 3rd Floor, Thomasville, GA 31792-6676 | 2006-08-31 |
| 1538276332 | Fred Mcconnel | Otolaryngology | 1670 Clairmont Rd, Surgical Service 112, Decatur, GA 30033-4004 | 2006-08-25 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.