Healthcare Provider Details

I. General information

NPI: 1184881229
Provider Name (Legal Business Name): ALLERGY & ASTHMA ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 CREEKSIDE VILLAGE DR NW SUITE 201
KENNESAW GA
30144-2324
US

IV. Provider business mailing address

3104 CREEKSIDE VILLAGE DRIVE SUITE 201
KENNESAW GA
30144-2334
US

V. Phone/Fax

Practice location:
  • Phone: 770-529-0460
  • Fax:
Mailing address:
  • Phone: 770-529-0460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number56408
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number56408
License Number StateGA

VIII. Authorized Official

Name: LENA BUCKLE
Title or Position: MANAGER
Credential:
Phone: 770-529-0460