Provider Demographics
NPI:1730134180
Name:THE ALLERGY & ASTHMA GROUP P.C.
Entity Type:Organization
Organization Name:THE ALLERGY & ASTHMA GROUP P.C.
Other - Org Name:ASTHMA, IMMUNOLOGY & ALLERGY ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:423-499-4100
Mailing Address - Street 1:1720 GUNBARREL RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421
Mailing Address - Country:US
Mailing Address - Phone:423-499-4100
Mailing Address - Fax:423-308-1808
Practice Address - Street 1:1720 GUNBARREL RD
Practice Address - Street 2:SUITE 400
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421
Practice Address - Country:US
Practice Address - Phone:423-499-4100
Practice Address - Fax:423-308-1808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3710236Medicare ID - Type Unspecified