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Organization
MIDDLE GEORGIA ALLERGY ASTHMA AND IMMUNOLOGY CENTER LLC
Active
Organization
MIDDLE GEORGIA ALLERGY ASTHMA AND IMMUNOLOGY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VENKAT DIVYA VANGALA BS PSYCHOLOGY (PRACTICE MANAGER)
(478) 731-7235
Entity
Organization
Contact information
Practice address
3964 ELNORA DR, MACON, GA 31210-1825
(478) 477-1777
(478) 477-1779
Mailing address
3964 ELNORA DR, MACON, GA 31210-1825
(478) 731-7235
(478) 477-1779
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
12/09/2022
Last updated
12/16/2022
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