Healthcare Provider Details

I. General information

NPI: 1124464995
Provider Name (Legal Business Name): ALLIED PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2013
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7405 SHALLOWFORD RD SUITE 270
CHATTANOOGA TN
37421-2661
US

IV. Provider business mailing address

7405 SHALLOWFORD RD SUITE 270
CHATTANOOGA TN
37421-2661
US

V. Phone/Fax

Practice location:
  • Phone: 423-602-9545
  • Fax: 423-602-9546
Mailing address:
  • Phone: 423-602-9545
  • Fax: 423-602-9546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number49755
License Number StateTN

VIII. Authorized Official

Name: DELIA A WESSELS-ANDERSON
Title or Position: OWNER
Credential:
Phone: 775-881-8984