Provider Demographics
NPI:1518324177
Name:ALLERGY ONE, LLC
Entity Type:Organization
Organization Name:ALLERGY ONE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-580-6760
Mailing Address - Street 1:3001 MONROE HWY
Mailing Address - Street 2:BLDG 400A
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-8513
Mailing Address - Country:US
Mailing Address - Phone:706-389-8022
Mailing Address - Fax:888-378-2468
Practice Address - Street 1:2601 PARKWOOD DR
Practice Address - Street 2:SUITE B
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4758
Practice Address - Country:US
Practice Address - Phone:706-389-8022
Practice Address - Fax:888-378-2468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty