Organization
SOUTHERN ALLERGY AND MEDICAL CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SASHA LASHEA' BUSSELL (OWNER)
(423) 489-5841
Entity
Organization
Contact information
Practice address
109 MAIN ST, NEW TAZEWELL, TN 37825-6635
(423) 259-5704
(423) 259-5706
Mailing address
PO BOX 69, NEW TAZEWELL, TN 37824-0069
(423) 259-5704
(423) 259-5706
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
363A00000X
Physician Assistant
—
—
Other
Enumeration date
05/17/2019
Last updated
05/17/2019
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