Healthcare Provider Details

I. General information

NPI: 1396994802
Provider Name (Legal Business Name): COVENANT ALLERGY AND ASTHMA CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 05/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 MACKEY BRANCH DR SUITE 114
CHATTANOOGA TN
37421-3482
US

IV. Provider business mailing address

1350 MACKEY BRANCH DR SUITE 114
CHATTANOOGA TN
37421-3482
US

V. Phone/Fax

Practice location:
  • Phone: 423-468-3267
  • Fax: 423-468-3270
Mailing address:
  • Phone: 423-468-3267
  • Fax: 423-468-3270

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: SUSAN P RASCHAL
Title or Position: PRESIDENT
Credential: D.O.
Phone: 423-468-3267