Organization
THE SOUTHEAST ASTHMA AND ALLERGY CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDOLPH AUGUSTUS MALONE IV MD (PHYSICIAN)
(850) 656-6269
Entity
Organization
Contact information
Practice address
2804 REMINGTON GREEN CIR STE 1, TALLAHASSEE, FL 32308-8707
(850) 656-6269
(850) 877-5270
Mailing address
511 GORDON AVE, THOMASVILLE, GA 31792-6645
(229) 226-5616
(229) 226-7132
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
0034412
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000465671A
—
GA
Enumeration date
11/14/2011
Last updated
08/31/2022
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