Provider Demographics
NPI:1598796195
Name:ATLANTA ALLERGY & ASTHMA, PA
Entity type:Organization
Organization Name:ATLANTA ALLERGY & ASTHMA, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOMONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-508-5343
Mailing Address - Street 1:PO BOX 23662
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-3662
Mailing Address - Country:US
Mailing Address - Phone:770-953-3331
Mailing Address - Fax:770-615-6091
Practice Address - Street 1:2045 PEACHTREE RD NE STE 800
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1412
Practice Address - Country:US
Practice Address - Phone:709-533-3331
Practice Address - Fax:770-615-6091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207K00000X
GA207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300034675AMedicare UPIN