Provider Demographics
NPI:1750902185
Name:CENTER FOR ALLERGY AND ASTHMA SOUTHERN CRESCENT
Entity type:Organization
Organization Name:CENTER FOR ALLERGY AND ASTHMA SOUTHERN CRESCENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
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 STE 101
Mailing Address - Street 2:
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 1:1975 HIGHWAY 54 W STE 255
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4794
Practice Address - Country:US
Practice Address - Phone:770-459-0620
Practice Address - Fax:770-456-7604
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR ALLERGY & ASTHMA OF GEORGIA PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1336364793OtherNPI
GA1568563914OtherNPI