Provider Demographics
NPI:1952367765
Name:PEDIATRIC AND ADULT ALLERGY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:PEDIATRIC AND ADULT ALLERGY ASSOCIATES, P.C.
Other - Org Name:DAN S. SANDERS, III, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:MABRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-340-4731
Mailing Address - Street 1:300 20TH AVE N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2131
Mailing Address - Country:US
Mailing Address - Phone:615-340-4731
Mailing Address - Fax:615-340-4729
Practice Address - Street 1:300 20TH AVE N
Practice Address - Street 2:SUITE 100
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2131
Practice Address - Country:US
Practice Address - Phone:615-340-4731
Practice Address - Fax:615-340-4729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12279174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3704901Medicare ID - Type Unspecified
TNB58665Medicare UPIN