Healthcare Provider Details

I. General information

NPI: 1336162908
Provider Name (Legal Business Name): HIGHLANDS ALLERGY & ASTHMA CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 HIGHWAY 126
BRISTOL TN
37620-3310
US

IV. Provider business mailing address

933 HIGHWAY 126
BRISTOL TN
37620-3310
US

V. Phone/Fax

Practice location:
  • Phone: 423-844-7000
  • Fax: 423-844-7007
Mailing address:
  • Phone: 423-844-7000
  • Fax: 423-844-7007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberMD0000017754
License Number StateTN

VIII. Authorized Official

Name: DR. NEIL D WALLEN
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 423-844-7000