Healthcare Provider Details

I. General information

NPI: 1043339229
Provider Name (Legal Business Name): ALLERGY & ASTHMA CLINIC OF NORTHEAST GEORGIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 JESSE JEWELL PKWY SE
GAINESVILLE GA
30501-3779
US

IV. Provider business mailing address

520 JESSE JEWELL PKWY SE
GAINESVILLE GA
30501-3779
US

V. Phone/Fax

Practice location:
  • Phone: 770-534-0534
  • Fax: 770-532-4049
Mailing address:
  • Phone: 770-534-0534
  • Fax: 770-532-4049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MICHAEL JAMES MALONEY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 770-534-0534