Provider Demographics
NPI:1821270992
Name:ALLERGY & ASTHMA CLINIC OF NORTHEAST GEORGIA
Entity Type:Organization
Organization Name:ALLERGY & ASTHMA CLINIC OF NORTHEAST GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-534-0534
Mailing Address - Street 1:520 JESSE JEWELL PKWY SE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3779
Mailing Address - Country:US
Mailing Address - Phone:770-534-0534
Mailing Address - Fax:770-532-4049
Practice Address - Street 1:110 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HIAWASSEE
Practice Address - State:GA
Practice Address - Zip Code:30546-3408
Practice Address - Country:US
Practice Address - Phone:706-896-4402
Practice Address - Fax:770-532-4049
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLERGY & ASTHMA CLINIC OF NORTHEAST GEORGIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2026Medicare PIN