# STATUS ALLERGY CLINIC OF KINGSPORT

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

## Provider details

- **NPI number:** 1972811503
- **Authorized official:** NALINCHANDRA GOPALDAS SHAH MD (PRESIDENT - MD)
- **Authorized official phone:** (423) 247-1122

## Contact information

- **Practice address:** 1516 BRIDGEWATER DR., KINGSPORT, TN 37660
- **Practice address phone:** (423) 247-1122
- **Practice address fax:** (423) 247-3856
- **Mailing address:** P.O. BOX 3490, KINGSPORT, TN 37664
- **Mailing address phone:** (423) 247-1122
- **Mailing address fax:** (423) 247-3856

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207K00000X | Allergy & Immunology Physician | MD0000015776 | TN | Yes |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | MD0000015776 | TN | — |

## Other

- **Enumeration date:** 09/16/2010
- **Last updated:** 09/16/2010