Organization
LIVE OAK ALLERGY, ASTHMA & IMMUNOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MITCHELL DEWAYNE HENSON JR. (PRACTICE MANAGER)
(615) 477-4321
Entity
Organization
Contact information
Practice address
143 CANAL ST, SUITE 200, POOLER, GA 31322-6007
(615) 477-2226
Mailing address
143 CANAL ST, SUITE 200, POOLER, GA 31322-6007
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
073306
GA
Other
Enumeration date
02/28/2015
Last updated
02/28/2015
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