Provider Demographics
NPI:1215397252
Name:SOUTHERN ALLERGY & ASTHMA PC
Entity Type:Organization
Organization Name:SOUTHERN ALLERGY & ASTHMA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:EADES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-303-9355
Mailing Address - Street 1:5223 PAULSEN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4700
Mailing Address - Country:US
Mailing Address - Phone:912-303-9355
Mailing Address - Fax:
Practice Address - Street 1:423 S COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-9080
Practice Address - Country:US
Practice Address - Phone:912-303-9355
Practice Address - Fax:912-303-9355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA43360207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty