Healthcare Provider Details

I. General information

NPI: 1619474855
Provider Name (Legal Business Name): ALLERGY & ASTHMA AFFILIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 CONCORD RD STE 200
FARRAGUT TN
37934-2951
US

IV. Provider business mailing address

2121 HIGHLAND AVE
KNOXVILLE TN
37916-1111
US

V. Phone/Fax

Practice location:
  • Phone: 865-525-2640
  • Fax: 865-525-9536
Mailing address:
  • Phone: 865-525-2640
  • Fax: 865-525-9536

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: LOUIS S MAVROFF
Title or Position: PRACTICE MANAGER
Credential:
Phone: 865-525-2640