Southern Allergy and Medical Clinic, Inc.

Primary specialty

Allergy PhysicianTaxonomy code 207KA0200X

Legal business name

SOUTHERN ALLERGY AND MEDICAL CLINIC, INC.

Practice address

109 Main St
New Tazewell, TN 37825-6635

Phone

(423) 259-5704

Fax

(423) 259-5706

NPI assigned

May 17, 2019

Last updated

May 17, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sasha Lashea' Bussell

Title

Owner

Phone

(423) 489-5841

Specialties & licenses 3

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1558051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558051200000",
    "number": "1417513177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 69",
            "city": "NEW TAZEWELL",
            "state": "TN",
            "postal_code": "378240069",
            "telephone_number": "423-259-5704",
            "fax_number": "423-259-5706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 MAIN ST",
            "city": "NEW TAZEWELL",
            "state": "TN",
            "postal_code": "378256635",
            "telephone_number": "423-259-5704",
            "fax_number": "423-259-5706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ALLERGY AND MEDICAL CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-17",
        "last_updated": "2019-05-17",
        "status": "A",
        "authorized_official_last_name": "BUSSELL",
        "authorized_official_first_name": "SASHA",
        "authorized_official_middle_name": "LASHEA'",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-489-5841"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207KA0200X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Allergy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hafeezul Hasan Siddiqui, MD
• Kristy N Slone, PHARM.D.
• Katherine Teresa Smith
• Leah Cobb Snodgrass, M.D.
• Southeastern Associated Medical Services
• SRH Health Inc
• Stanifer Pharmacy LLC (Stanifer Drugs, LLC)
• Stanifer Pharmacy LLC (Stanifer Drugs)
• William R Stanifer Jr., DPH
• State of Tennessee (Claiborne County Health Department)

• Allergy Physician in New Tazewell, TN
• Providers in New Tazewell, TN by specialty
• Allergy Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.