Provider Demographics
NPI:1134360910
Name:ALLERGY ASSOCIATES, PA
Entity type:Organization
Organization Name:ALLERGY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:OVERHOLT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-584-8588
Mailing Address - Street 1:801 N WEISGARBER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2706
Mailing Address - Country:US
Mailing Address - Phone:865-584-8588
Mailing Address - Fax:865-450-9904
Practice Address - Street 1:801 N WEISGARBER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2706
Practice Address - Country:US
Practice Address - Phone:865-584-8588
Practice Address - Fax:865-450-9904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD4738174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3149477Medicaid
TN3149477Medicaid