Provider Demographics
NPI:1104212612
Name:PAINE, ALLISON ROGERS (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:ROGERS
Last Name:PAINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 FURYS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-9059
Mailing Address - Country:US
Mailing Address - Phone:706-691-7079
Mailing Address - Fax:706-364-0416
Practice Address - Street 1:575 FURYS FERRY RD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-9059
Practice Address - Country:US
Practice Address - Phone:706-691-7079
Practice Address - Fax:706-364-0416
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA83220207N00000X, 207ND0101X
390200000X
PAMT209874207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT209874OtherPENNSYLVANIA TRAINING LISCENCE