Healthcare Provider Details

I. General information

NPI: 1225158116
Provider Name (Legal Business Name): ALLERGY & ASTHMA OF ATLANTA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 PEACHTREE RD NE TOWER PLACE 100, SUITE 600
ATLANTA GA
30326-1000
US

IV. Provider business mailing address

3340 PEACHTREE RD NE TOWER PLACE 100, SUITE 600
ATLANTA GA
30326-1000
US

V. Phone/Fax

Practice location:
  • Phone: 404-266-9876
  • Fax: 404-266-2669
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number059015
License Number StateGA

VIII. Authorized Official

Name: DR. LUQMAN SEIDU
Title or Position: PARTNER
Credential: M.D.
Phone: 330-289-1783