Lakeside Allergy Asthma and Immunology LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

75964 Issued in GA

Legal business name

LAKESIDE ALLERGY ASTHMA AND IMMUNOLOGY LLC

Practice address

3500 Duluth Park LN Ste 820
Duluth, GA 30096-3243

Phone

(678) 226-9866

Fax

(678) 373-3983

NPI assigned

Feb 21, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Li Zuo, MDNPI 1023225190

Title

Ceo

Phone

(513) 535-0946

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Li Zuo, MD

  • Allergy & Immunology Physician
  • Duluth, GA
  • NPI 1023225190
  Medicare reassignment NPD Authorized official
• Paula Abby Rothman, MD

  • Gynecology Physician
  • Atlanta, GA
  • NPI 1235211442
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1487635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666137600000",
    "number": "1104365279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2227",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300960039",
            "telephone_number": "678-837-5224",
            "fax_number": "404-860-1298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 DULUTH PARK LN STE 820",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300963243",
            "telephone_number": "678-226-9866",
            "fax_number": "678-373-3983"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3790 Pleasant Hill Rd",
            "address_2": "Suite 200",
            "address_purpose": "LOCATION",
            "city": "Duluth",
            "state": "GA",
            "postal_code": "300965142",
            "country_code": "US",
            "telephone_number": "678-837-5224",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LAKESIDE ALLERGY ASTHMA AND IMMUNOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-21",
        "last_updated": "2022-10-19",
        "certification_date": "2022-10-19",
        "status": "A",
        "authorized_official_last_name": "ZUO",
        "authorized_official_first_name": "LI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "513-535-0946",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "GA",
            "license": "75964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Thaddeus Ivory Lancaster, MD

• Medical Specialty Clinic/Center in Duluth, GA
• Providers in Duluth, GA by specialty
• Medical Specialty Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.