Healthcare Provider Details

I. General information

NPI: 1417142092
Provider Name (Legal Business Name): THOMAS G ALLEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 MAIN ST STE A
WARTBURG TN
37887-4310
US

IV. Provider business mailing address

950 MAIN ST STE A
WARTBURG TN
37887-4310
US

V. Phone/Fax

Practice location:
  • Phone: 423-346-2620
  • Fax: 423-346-2624
Mailing address:
  • Phone: 423-346-2620
  • Fax: 423-346-2624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD0000015065
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMD0000015065
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD0000015065
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License NumberMD0000015065
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD0000015065
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD0000015065
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License NumberMD0000015065
License Number StateTN
# 8
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD0000015065
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: