# EAST MEMPHIS ALLERGY AND ASTHMA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447454319
- **Authorized official:** DR. BETTY VAN HOOSER MIRRO M.D. (MEDICAL DOCTOR, BUSINESS OWNER)
- **Authorized official phone:** (901) 755-0550

## Contact information

- **Practice address:** 3085 FOUNTAINSIDE DR, SUITE 202, GERMANTOWN, TN 38138-7842
- **Practice address phone:** (901) 755-0550
- **Practice address fax:** (901) 755-0474
- **Mailing address:** 3085 FOUNTAINSIDE DR, SUITE 202, GERMANTOWN, TN 38138-7842
- **Mailing address phone:** (901) 755-0550
- **Mailing address fax:** (901) 755-0474

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207K00000X | Allergy & Immunology Physician | — | NULL | Yes |
| 207K00000X | Allergy & Immunology Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/13/2007
- **Last updated:** 03/08/2017