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General NPI Number Information
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NPI Number | 1376952234
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Entity Type | Organization
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Legal Business Name | ALLERGY SINUS AND COUGH CENTER OF GEORGIA, INC
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Dates
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Enumeration Date | 08/05/2014
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Last Update Date | 08/05/2014
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Provider Practice Location Address
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Address Line | 4000 SHAKERAG HL SUITE 300
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-4047
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Country | US
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Telephone | 262-327-0704
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Fax | 678-669-2401
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Provider Business Mailing Address
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Address Line | 4000 SHAKERAG HL SUITE 300
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-4047
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Country | US
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Telephone | 262-327-0704
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Fax | 678-669-2401
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RUCHIR AGRAWAL
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Credential | M.D.
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Telephone | 262-327-0704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0201X
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Taxonomy Name | Pediatric Allergy/Immunology Physician
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License Number | 68876
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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 | 68876
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License Number State | GA
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