Provider Demographics
NPI:1114752821
Name:ALLERGY, ASTHMA, IMMUNOLOGY CENTER - TY PRINCE, PLLC
Entity type:Organization
Organization Name:ALLERGY, ASTHMA, IMMUNOLOGY CENTER - TY PRINCE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HAMBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-273-0008
Mailing Address - Street 1:616 W. LAMAR ALEXANDER PARKWAY
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801
Mailing Address - Country:US
Mailing Address - Phone:865-273-0008
Mailing Address - Fax:
Practice Address - Street 1:616 W. LAMAR ALEXANDER PARKWAY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801
Practice Address - Country:US
Practice Address - Phone:865-273-0008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-03
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty