Healthcare Provider Details

I. General information

NPI: 1518242601
Provider Name (Legal Business Name): ALLERGY ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3951 RIDGE AVE SUITE C
MACON GA
31210-5050
US

IV. Provider business mailing address

6701 BAUM DR SUITE 140
KNOXVILLE TN
37919-7360
US

V. Phone/Fax

Practice location:
  • Phone: 865-584-8588
  • Fax: 865-584-3364
Mailing address:
  • Phone: 865-584-5727
  • Fax: 865-450-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT MARION OVERHOLT
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 865-584-5727