The Southeast Asthma and Allergy Center PC

Primary specialty

Allergy PhysicianTaxonomy code 207KA0200X

License

0034412 Issued in GA

Legal business name

THE SOUTHEAST ASTHMA AND ALLERGY CENTER PC

Practice address

2804 Remington Green Cir Ste 1
Tallahassee, FL 32308-8707

Phone

(850) 656-6269

Fax

(850) 877-5270

NPI assigned

Nov 14, 2011

Last updated

Aug 31, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Randolph Augustus Malone IV, MDNPI 1497726814

Title

Physician

Phone

(850) 656-6269

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Randolph Augustus Malone IV, M.D.

  • Allergy Physician
  • Tallahassee, FL
  • NPI 1497726814
  Medicare reassignment Authorized official
• Dwight Luke Polivka, ARNP

  • Family Nurse Practitioner
  • Tallahassee, FL
  • NPI 1750399150
  NPD
• Kimberly Ann Gray, ARNP-C

  • Family Nurse Practitioner
  • Tallahassee, FL
  • NPI 1780186213
  NPD (past)

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

{
    "created_epoch": "1321228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661904000000",
    "number": "1295012631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 GORDON AVE",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317926645",
            "telephone_number": "229-226-5616",
            "fax_number": "229-226-7132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2804 REMINGTON GREEN CIR STE 1",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323088707",
            "telephone_number": "850-656-6269",
            "fax_number": "850-877-5270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SOUTHEAST ASTHMA AND ALLERGY CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-14",
        "last_updated": "2022-08-31",
        "certification_date": "2022-08-31",
        "status": "A",
        "authorized_official_last_name": "MALONE",
        "authorized_official_first_name": "RANDOLPH",
        "authorized_official_middle_name": "AUGUSTUS",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "850-656-6269",
        "authorized_official_name_suffix": "IV",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Allergy & Immunology, Allergy",
            "state": "GA",
            "license": "0034412",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000465671A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• The Love Identity Foundation & Encouragement Center, Inc. (The LIFE Center, Inc.)
• The Minority Alliance for Advocating Community Awareness and Action, I (Maaca, Inc.)
• The Seasoned Relaxation Ctr LLC
• The Shoe Box
• The Smile Mission Tallahassee PLLC
• The Southern Institute for Family & Community Preservation, Inc.
• The Sweetest Sitters
• The Thomas House Inc.
• The Vein Valet
• Kimberly Thelusme

• Allergy Physician in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Allergy Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 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.