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NPI Code Detail

MEDICARE: ALLERGY & ASTHMA CLINIC OF NORTHEAST GEORGIA

MEDICARE: ALLERGY & ASTHMA CLINIC OF NORTHEAST GEORGIA
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
1207KA0200XAllergy Physician

General Provider Information

NPI Number : 1821270992
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALLERGY & ASTHMA CLINIC OF NORTHEAST GEORGIA
Provider Business Mailing Address
First Line : 520 JESSE JEWELL PKWY SE
Second Line :
City : GAINESVILLE
State : GA
Zip : 30501-3779
Country : US
Telephone Number : 770-534-0534
Fax Number : 770-532-4049
Provider Business Practice Location Address
First Line : 110 S MAIN ST
Second Line :
City : HIAWASSEE
State : GA
Zip : 30546-3408
Country : US
Telephone Number : 706-896-4402
Fax Number : 770-532-4049
Authorized Official
Title or Position : OFFICE MANAGER
Name : MS. LESLIE MORRIS
Credential :
Telephone Number : 770-534-0534
Provider Enumeration Date : 11/30/2007
Last Update Date : 11/30/2007

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Directions to “ALLERGY & ASTHMA CLINIC OF NORTHEAST GEORGIA ” Practice Location

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