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General NPI Number Information
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NPI Number | 1033213764
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Entity Type | Organization
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Legal Business Name | EAST TENNESSEE ALLERGY PC
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 08/24/2010
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Provider Practice Location Address
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Address Line | 1120 E WEISGARBER RD STE 102
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City | KNOXVILLE
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State | TN
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Zip | 37909
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Country | US
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Telephone | 865-584-2071
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Fax | 865-584-2165
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Provider Business Mailing Address
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Address Line | 1120 E WEISGARBER RD STE 102
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City | KNOXVILLE
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State | TN
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Zip | 37909
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Country | US
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Telephone | 865-584-2071
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Fax | 865-584-2165
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Authorized Official
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Title or Position | PRESIDENT STA
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Name | DR. JEFFREY LLOYD SCHLACTUS
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Credential | MD
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Telephone | 865-584-2071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | MD16984
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License Number State | TN
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