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General NPI Number Information
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NPI Number | 1700076155
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Entity Type | Organization
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Legal Business Name | ALLERGY & ASTHMA CENTER PC MD
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Dates
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Enumeration Date | 07/31/2007
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Last Update Date | 04/23/2019
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Provider Practice Location Address
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Address Line | 308 SUNSET DR SUITE 1
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2489
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Country | US
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Telephone | 423-282-2822
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Fax | 423-282-5492
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Provider Business Mailing Address
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Address Line | 308 SUNSET DR SUITE 1
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2489
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Country | US
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Telephone | 423-282-2822
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Fax | 423-282-5492
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | MRS. DONNA LEE WYCHE
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Credential | M.D.
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Telephone | 423-282-2822
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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 | MD0000020021
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License Number State | TN
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