Provider Demographics
NPI:1265645089
Name:ALLERGY & ASTHMA SPECIALISTS
Entity Type:Organization
Organization Name:ALLERGY & ASTHMA SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYASAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PRASAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-474-7800
Mailing Address - Street 1:1520 ROCK QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7386
Mailing Address - Country:US
Mailing Address - Phone:770-474-7800
Mailing Address - Fax:770-474-0608
Practice Address - Street 1:1520 ROCK QUARRY RD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7386
Practice Address - Country:US
Practice Address - Phone:770-474-7800
Practice Address - Fax:770-474-0608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020795174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD40896Medicare UPIN