Provider Demographics
NPI:1467630723
Name:ALLERGY AND ASTHMA SPECIALISTS OF MEMPHIS, PC
Entity Type:Organization
Organization Name:ALLERGY AND ASTHMA SPECIALISTS OF MEMPHIS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:SADDIK
Authorized Official - Last Name:FAHHOUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-202-4100
Mailing Address - Street 1:2006 EXETER RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3945
Mailing Address - Country:US
Mailing Address - Phone:901-202-4100
Mailing Address - Fax:901-202-4102
Practice Address - Street 1:2006 EXETER RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3945
Practice Address - Country:US
Practice Address - Phone:901-202-4100
Practice Address - Fax:901-202-4102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000024839174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3081451Medicare PIN
TNF63238Medicare UPIN