Provider Demographics
NPI:1417442757
Name:ALLERGY ASTHMA IMMUNOLOGY CENTER, PLLC
Entity Type:Organization
Organization Name:ALLERGY ASTHMA IMMUNOLOGY CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-757-6100
Mailing Address - Street 1:6139 CHAPELLE CIR W
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-4062
Mailing Address - Country:US
Mailing Address - Phone:901-757-6100
Mailing Address - Fax:901-757-6109
Practice Address - Street 1:6401 POPLAR AVE STE 300
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4810
Practice Address - Country:US
Practice Address - Phone:901-757-6100
Practice Address - Fax:901-757-6109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty