Healthcare Provider Details

I. General information

NPI: 1114136561
Provider Name (Legal Business Name): ALLEN ALLIED HEALTHCARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 PRINCETON RD STE 1
JOHNSON CITY TN
37601-2040
US

IV. Provider business mailing address

403 PRINCETON RD STE 1
JOHNSON CITY TN
37601-2040
US

V. Phone/Fax

Practice location:
  • Phone: 423-283-9913
  • Fax: 423-283-9908
Mailing address:
  • Phone: 423-283-9913
  • Fax: 423-283-9908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberAPN6312
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAREN G HATHAWAY
Title or Position: OWNER/PROVIDER
Credential: ANP-C
Phone: 423-283-9913