Healthcare Provider Details

I. General information

NPI: 1952534703
Provider Name (Legal Business Name): ALLERGYCARE OF COOL SPRINGS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 12/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 COOL SPRINGS BLVD STE. 120
FRANKLIN TN
37067-6448
US

IV. Provider business mailing address

740 COOL SPRINGS BLVD STE. 120
FRANKLIN TN
37067-6448
US

V. Phone/Fax

Practice location:
  • Phone: 615-778-0611
  • Fax: 615-778-0673
Mailing address:
  • Phone: 615-778-0611
  • Fax: 615-778-0673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number4298
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number4298
License Number StateTN

VIII. Authorized Official

Name: ROBERT C. OWEN
Title or Position: OWNER/DIRECTOR/MD
Credential: MD
Phone: 615-778-0611