MEDICARE: ATLANTA ALLERGY & ASTHMA CLINIC PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician

General Provider Information

NPI Number	:	1598796195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTA ALLERGY & ASTHMA CLINIC PA

Provider Business Mailing Address
First Line	:	PO BOX 23662
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-3662
Country	:	US
Telephone Number	:	770-953-3331
Fax Number	:	770-615-6091

Provider Business Practice Location Address
First Line	:	2045 PEACHTREE RD NE STE 800
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-1412
Country	:	US
Telephone Number	:	709-533-3331
Fax Number	:	770-615-6091

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	JENNIFER HENDRICKS
Credential	:
Telephone Number	:	678-457-9615

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	11/11/2025

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