Provider Demographics
NPI:1801234885
Name:ALLERGY SPECIALISTS OF GEORGIA
Entity type:Organization
Organization Name:ALLERGY SPECIALISTS OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAILESH
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTHARI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-423-6840
Mailing Address - Street 1:2643 CALDWELL RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3118
Mailing Address - Country:US
Mailing Address - Phone:404-423-6840
Mailing Address - Fax:770-216-1509
Practice Address - Street 1:438 HENRY FORD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30354
Practice Address - Country:US
Practice Address - Phone:678-235-2401
Practice Address - Fax:678-235-2403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA58930207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty