Provider Demographics
NPI:1851560700
Name:BILLY J ALLEN MD PC
Entity Type:Organization
Organization Name:BILLY J ALLEN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDEN
Authorized Official - Prefix:DR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-238-5668
Mailing Address - Street 1:PO BOX 731
Mailing Address - Street 2:5623 OOLTEWAH-RINGGOLD ROAD
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-0731
Mailing Address - Country:US
Mailing Address - Phone:423-238-5668
Mailing Address - Fax:
Practice Address - Street 1:5623 OOLTEWAH RINGGOLD RD
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-7806
Practice Address - Country:US
Practice Address - Phone:423-238-5668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4706207Q00000X
TN14062207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2004003OtherBLUE CROSS BLUE SHIELD
TN0036498OtherBLUE CROSS BLUE SHIELD
TN2004003OtherBLUE CROSS BLUE SHIELD
TNB01563Medicare UPIN