Provider Demographics
NPI:1578776381
Name:SOUTH GEORGIA PEDIATRIC AND ALLERGY CENTER
Entity Type:Organization
Organization Name:SOUTH GEORGIA PEDIATRIC AND ALLERGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ALVARADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-247-2211
Mailing Address - Street 1:3440 N VALDOSTA RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1079
Mailing Address - Country:US
Mailing Address - Phone:229-247-2211
Mailing Address - Fax:229-247-9313
Practice Address - Street 1:3440 N VALDOSTA RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1079
Practice Address - Country:US
Practice Address - Phone:229-247-2211
Practice Address - Fax:229-247-9313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037463207K00000X, 208000000X, 2080A0000X
GA048706208000000X, 2080A0000X
GA053436208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Not Answered2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty