Provider Demographics
NPI:1467671305
Name:THE ALLERGY & ASTHMA CENTER, LLC
Entity Type:Organization
Organization Name:THE ALLERGY & ASTHMA CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:B
Authorized Official - Last Name:CRUMBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:770-922-5696
Mailing Address - Street 1:2390 WALL ST SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2186
Mailing Address - Country:US
Mailing Address - Phone:770-922-5696
Mailing Address - Fax:770-922-4353
Practice Address - Street 1:2390 WALL ST SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2186
Practice Address - Country:US
Practice Address - Phone:770-922-5696
Practice Address - Fax:770-922-4353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACI5409OtherRR MEDICARE PIN
GA=========OtherTAX ID
GA=========OtherTAX ID