Healthcare Provider Details

I. General information

NPI: 1043885635
Provider Name (Legal Business Name): CHILDREN ALLERGY TESTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 CANDLER RD STE 9
DECATUR GA
30034-1415
US

IV. Provider business mailing address

2855 CANDLER RD STE 9
DECATUR GA
30034-1415
US

V. Phone/Fax

Practice location:
  • Phone: 770-802-0329
  • Fax: 404-243-8721
Mailing address:
  • Phone: 770-802-0329
  • Fax: 404-243-8721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RUNETTE FLOWERS
Title or Position: DOCTOR
Credential: MD
Phone: 770-802-0329