Provider Demographics
NPI:1811035652
Name:PEACHTREE ALLERGY AND ASTHMA CLINIC PC
Entity Type:Organization
Organization Name:PEACHTREE ALLERGY AND ASTHMA CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-351-7520
Mailing Address - Street 1:1800 PEACHTREE ST NW
Mailing Address - Street 2:SUITE 720
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2519
Mailing Address - Country:US
Mailing Address - Phone:404-351-7520
Mailing Address - Fax:404-355-2048
Practice Address - Street 1:1800 PEACHTREE ST NW
Practice Address - Street 2:SUITE 720
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2519
Practice Address - Country:US
Practice Address - Phone:404-351-7520
Practice Address - Fax:404-355-2048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D40428Medicare UPIN
03BDBSKMedicare ID - Type Unspecified
H37976Medicare UPIN
03BDBDVMedicare ID - Type Unspecified
F56951Medicare UPIN
D31367Medicare UPIN
H11551Medicare UPIN
03BDBRNMedicare ID - Type Unspecified
03BDBQRMedicare ID - Type Unspecified
252782495AMedicare ID - Type Unspecified