Provider Demographics
NPI:1366969560
Name:ALLERGY CONSULTING GROUP, LLC
Entity type:Organization
Organization Name:ALLERGY CONSULTING GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:REZNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-652-3667
Mailing Address - Street 1:PO BOX 501741
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31150-1741
Mailing Address - Country:US
Mailing Address - Phone:770-652-3667
Mailing Address - Fax:770-573-3611
Practice Address - Street 1:5752B BUFORD HWY NE
Practice Address - Street 2:
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-1207
Practice Address - Country:US
Practice Address - Phone:770-652-3667
Practice Address - Fax:770-573-3611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty