Provider Demographics
NPI:1003073990
Name:ALLEN MARKHAM, KANDACE DANIELLE (PA)
Entity Type:Individual
Prefix:MRS
First Name:KANDACE
Middle Name:DANIELLE
Last Name:ALLEN MARKHAM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:KANDACE
Other - Middle Name:DANIELLE
Other - Last Name:MARKHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 SPARTA RD STE F
Mailing Address - Street 2:
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082-1392
Mailing Address - Country:US
Mailing Address - Phone:478-552-0001
Mailing Address - Fax:478-552-0048
Practice Address - Street 1:501 SPARTA RD STE F
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-1392
Practice Address - Country:US
Practice Address - Phone:478-552-0001
Practice Address - Fax:478-552-0048
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1722363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA899248448BMedicaid
GA899248448AMedicaid