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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