Provider Demographics
NPI:1295226157
Name:JACKSON ALLERGY & ASTHMA CLINIC PLLC
Entity Type:Organization
Organization Name:JACKSON ALLERGY & ASTHMA CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEJARNATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-660-0138
Mailing Address - Street 1:464 N PARKWAY STE D
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2810
Mailing Address - Country:US
Mailing Address - Phone:731-660-0138
Mailing Address - Fax:731-660-0133
Practice Address - Street 1:464 N PARKWAY STE D
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2810
Practice Address - Country:US
Practice Address - Phone:731-660-0138
Practice Address - Fax:731-660-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty