Healthcare Provider Details

I. General information

NPI: 1952367765
Provider Name (Legal Business Name): PEDIATRIC AND ADULT ALLERGY ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 11/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 20TH AVE N SUITE 100
NASHVILLE TN
37203-2131
US

IV. Provider business mailing address

300 20TH AVE N SUITE 100
NASHVILLE TN
37203-2131
US

V. Phone/Fax

Practice location:
  • Phone: 615-340-4731
  • Fax: 615-340-4729
Mailing address:
  • Phone: 615-340-4731
  • Fax: 615-340-4729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number12279
License Number StateTN

VIII. Authorized Official

Name: BETTY MABRY
Title or Position: CORPORATE SECRETARY
Credential:
Phone: 615-340-4731