Provider Demographics
NPI:1376952234
Name:ALLERGY SINUS AND COUGH CENTER OF GEORGIA, INC
Entity Type:Organization
Organization Name:ALLERGY SINUS AND COUGH CENTER OF GEORGIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUCHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:AGRAWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-327-0704
Mailing Address - Street 1:4000 SHAKERAG HL
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4047
Mailing Address - Country:US
Mailing Address - Phone:262-327-0704
Mailing Address - Fax:678-669-2401
Practice Address - Street 1:4000 SHAKERAG HL
Practice Address - Street 2:SUITE 300
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4047
Practice Address - Country:US
Practice Address - Phone:262-327-0704
Practice Address - Fax:678-669-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA68876207K00000X, 2080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/ImmunologyGroup - Multi-Specialty