Healthcare Provider Details

I. General information

NPI: 1598796195
Provider Name (Legal Business Name): ATLANTA ALLERGY & ASTHMA CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 PEACHTREE RD NE STE 800
ATLANTA GA
30309-1412
US

IV. Provider business mailing address

PO BOX 23662
NEW YORK NY
10087-3662
US

V. Phone/Fax

Practice location:
  • Phone: 709-533-3331
  • Fax: 770-615-6091
Mailing address:
  • Phone: 770-953-3331
  • Fax: 770-615-6091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER HENDRICKS
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 678-457-9615