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General NPI Number Information
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NPI Number | 1184881229
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Entity Type | Organization
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Legal Business Name | ALLERGY & ASTHMA ASSOCIATES LLC
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Dates
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Enumeration Date | 05/16/2008
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 3104 CREEKSIDE VILLAGE DR NW SUITE 201
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City | KENNESAW
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State | GA
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Zip | 30144-2324
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Country | US
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Telephone | 770-529-0460
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Fax |
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Provider Business Mailing Address
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Address Line | 3104 CREEKSIDE VILLAGE DRIVE SUITE 201
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City | KENNESAW
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State | GA
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Zip | 30144-2334
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Country | US
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Telephone | 770-529-0460
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | LENA BUCKLE
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Credential |
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Telephone | 770-529-0460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 56408
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 56408
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License Number State | GA
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