1952682098 NPI number — ALLERGY & ASTHMA AFFILIATES, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952682098 NPI number — ALLERGY & ASTHMA AFFILIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLERGY & ASTHMA AFFILIATES, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952682098
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2121 HIGHLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37916-1111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-525-2640
Provider Business Mailing Address Fax Number:
865-525-9536

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
808 W 4TH NORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORRISTOWN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37814-3813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-525-2640
Provider Business Practice Location Address Fax Number:
865-525-9536
Provider Enumeration Date:
09/02/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ELLENBURG
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
TRENT
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
865-525-2640

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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