Provider Demographics
NPI:1083744312
Name:ALLERGY & ASTHMA CARE CENTER, LLC
Entity Type:Organization
Organization Name:ALLERGY & ASTHMA CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:HARDIGREE
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-534-9933
Mailing Address - Street 1:2510 LIMESTONE PKWY
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2089
Mailing Address - Country:US
Mailing Address - Phone:770-534-9933
Mailing Address - Fax:770-534-8999
Practice Address - Street 1:2510 LIMESTONE PKWY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2089
Practice Address - Country:US
Practice Address - Phone:770-534-9933
Practice Address - Fax:770-534-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4362Medicare ID - Type UnspecifiedMEDICARE GROUP ID