Provider Demographics
NPI:1578504536
Name:CENTER FOR ALLERGY & ASTHMA OF GEORGIA PC
Entity Type:Organization
Organization Name:CENTER FOR ALLERGY & ASTHMA OF GEORGIA PC
Other - Org Name:CENTER FOR ALLERGY & ASTHMA OF WEST GA PC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:S
Authorized Official - Last Name:HURWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-459-0620
Mailing Address - Street 1:690 DALLAS HWY
Mailing Address - Street 2:STE 101
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-1262
Mailing Address - Country:US
Mailing Address - Phone:770-459-0620
Mailing Address - Fax:770-456-7604
Practice Address - Street 1:690 DALLAS HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180
Practice Address - Country:US
Practice Address - Phone:770-836-7987
Practice Address - Fax:770-836-0145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF33495Medicare UPIN
GAGRP4844Medicare ID - Type UnspecifiedMEDICARE GROUP #