Organization
ALLERGY & IMMUNOLOGY CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSE THECKEDATH MD (PRESIDENT/CEO)
(229) 446-7227
Entity
Organization
Contact information
Practice address
1911 PALMYRA RD, ALBANY, GA 31701-1574
(229) 446-7227
(229) 420-4365
Mailing address
1911 PALMYRA RD, ALBANY, GA 31701-1574
(229) 446-7227
(229) 420-4365
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
045992
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300034628A
—
GA
Enumeration date
08/29/2011
Last updated
03/20/2013
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