Provider Demographics
NPI:1144641275
Name:PREMIER ALLERGY & ASTHMA LLC
Entity type:Organization
Organization Name:PREMIER ALLERGY & ASTHMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, BC, FNP
Authorized Official - Phone:404-402-0220
Mailing Address - Street 1:6135 RIVER SHORE PKWY
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5109 HIGHWAY 278 NE STE D
Practice Address - Street 2:SUITE D
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2608
Practice Address - Country:US
Practice Address - Phone:404-402-0220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPRO1106261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000926197OMedicaid
GA000926197OMedicaid