Healthcare Provider Details

I. General information

NPI: 1851560700
Provider Name (Legal Business Name): BILLY J ALLEN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5623 OOLTEWAH RINGGOLD RD
OOLTEWAH TN
37363-7806
US

IV. Provider business mailing address

PO BOX 731 5623 OOLTEWAH-RINGGOLD ROAD
OOLTEWAH TN
37363-0731
US

V. Phone/Fax

Practice location:
  • Phone: 423-238-5668
  • Fax:
Mailing address:
  • Phone: 423-238-5668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4706
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number14062
License Number StateTN

VIII. Authorized Official

Name: DR. BILLY J ALLEN
Title or Position: PRESIDEN
Credential: M.D.
Phone: 423-238-5668