Provider Demographics
NPI:1760660187
Name:ALLERGY & ASTHMA AFFILIATES, PC
Entity Type:Organization
Organization Name:ALLERGY & ASTHMA AFFILIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:T
Authorized Official - Last Name:ELLENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-525-2640
Mailing Address - Street 1:2121 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1111
Mailing Address - Country:US
Mailing Address - Phone:865-525-2640
Mailing Address - Fax:
Practice Address - Street 1:632 DOLLY PARTON PKWY # 5
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-3601
Practice Address - Country:US
Practice Address - Phone:865-429-9070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3705744Medicare UPIN