Provider Demographics
NPI:1093997447
Name:ALLERGY & ASTHMA CLINICS OF GA
Entity Type:Organization
Organization Name:ALLERGY & ASTHMA CLINICS OF GA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:T.
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MOREE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:229-438-7100
Mailing Address - Street 1:105 SPANISH CT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-1282
Mailing Address - Country:US
Mailing Address - Phone:229-438-7100
Mailing Address - Fax:229-438-9382
Practice Address - Street 1:105 SPANISH CT
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-1282
Practice Address - Country:US
Practice Address - Phone:229-438-7100
Practice Address - Fax:229-438-9382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1386749117OtherNPI
1114017449OtherNPI
GA03BDBFPMedicare Oscar/Certification
GAGRP2390Medicare Oscar/Certification
1114017449OtherNPI