Provider Demographics
NPI:1467688630
Name:REDDING PEDIATRIC ALLERGY AND ASTHMA CENTER
Entity Type:Organization
Organization Name:REDDING PEDIATRIC ALLERGY AND ASTHMA CENTER
Other - Org Name:REDDING ALLERGY AND ASTHMA CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRIMARY MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-355-0078
Mailing Address - Street 1:3193 HOWELL MILL RD NW
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-2119
Mailing Address - Country:US
Mailing Address - Phone:404-355-0078
Mailing Address - Fax:
Practice Address - Street 1:3193 HOWELL MILL RD NW
Practice Address - Street 2:STE 102
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2119
Practice Address - Country:US
Practice Address - Phone:404-355-0078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REDDING ALLERGY AND ASTHMA CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-02
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA61327207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty