Live Oak Allergy, Asthma & Immunology, LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

073306 Issued in GA

Legal business name

LIVE OAK ALLERGY, ASTHMA & IMMUNOLOGY, LLC

Practice address

143 Canal St
Suite 200
Pooler, GA 31322-6007

Phone

(615) 477-2226

NPI assigned

Feb 28, 2015

Last updated

Feb 28, 2015By 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

Mitchell Dewayne Henson Jr.

Title

Practice Manager

Phone

(615) 477-4321

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

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.

• Michele Henson, MD

  • Allergy & Immunology Physician
  • Pooler, GA
  • NPI 1306993126
  Medicare reassignment NPD

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

{
    "created_epoch": "1425081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425081600000",
    "number": "1689066649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "143 CANAL ST",
            "address_2": "SUITE 200",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313226007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "143 CANAL ST",
            "address_2": "SUITE 200",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313226007",
            "telephone_number": "615-477-2226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVE OAK ALLERGY, ASTHMA & IMMUNOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-28",
        "last_updated": "2015-02-28",
        "status": "A",
        "authorized_official_last_name": "HENSON",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_middle_name": "DEWAYNE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "615-477-4321",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "GA",
            "license": "073306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Life Line Home Care Inc
• Lincare Inc.
• Linker Health and Wellness
• Brandon Michael Linker, D.C.
• Little P.C.
• Leah Andree Jermarv Lloyd, LPC
• Tara Locke, PHARMD
• Haley Katherine Lockwood
• Elise Lopez
• Lords Saving Grace Health Services LLC

• Medical Specialty Clinic/Center in Pooler, GA
• Providers in Pooler, 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 Feb 28, 2015; 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.