Provider Demographics
NPI:1033213764
Name:EAST TENNESSEE ALLERGY PC
Entity Type:Organization
Organization Name:EAST TENNESSEE ALLERGY PC
Other - Org Name:JEFFREY L SCHLACTUS MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT STA
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:SCHLACTUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-584-2071
Mailing Address - Street 1:1120 E WEISGARBER RD
Mailing Address - Street 2:STE 102
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909
Mailing Address - Country:US
Mailing Address - Phone:865-584-2071
Mailing Address - Fax:865-584-2165
Practice Address - Street 1:1120 E WEISGARBER RD
Practice Address - Street 2:STE 102
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909
Practice Address - Country:US
Practice Address - Phone:865-584-2071
Practice Address - Fax:865-584-2165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD16984207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN60072OtherBC
TN10011730Medicaid
TN3024286Medicare ID - Type Unspecified
TN10011730Medicaid