Provider Demographics
NPI:1164476149
Name:ALLEN, STANLEY LLEWELLYN III (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:LLEWELLYN
Last Name:ALLEN
Suffix:III
Gender:M
Credentials:MD
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Other - Middle Name:
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Mailing Address - Street 1:2400 MOUNT ZION PKWY
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2500
Mailing Address - Country:US
Mailing Address - Phone:404-365-0966
Mailing Address - Fax:
Practice Address - Street 1:2400 MT. ZION PARKWAY KAISER PERMANENTE
Practice Address - Street 2:SOUTHWOOD COMPREHENSIVE MEDICAL CENTER
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236
Practice Address - Country:US
Practice Address - Phone:770-365-0966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2009-00161207P00000X
GA062095207P00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine