Provider Demographics
NPI:1164522694
Name:ALLEYNE, AUDREY S (MD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:S
Last Name:ALLEYNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:DENISE
Other - Last Name:STAPLETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3824 HONORS WAY
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-9146
Mailing Address - Country:US
Mailing Address - Phone:706-267-5170
Mailing Address - Fax:706-863-1148
Practice Address - Street 1:2669 KINARD ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-2911
Practice Address - Country:US
Practice Address - Phone:803-276-7570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039479207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA915210274AMedicaid
SCG39479Medicaid
GAPOO135579OtherRAILROAD MEDICARE
GA001319OtherBCBS
GA339277OtherWELLCARE CMO
GA550789920OtherTRICARE
GA915210274BOtherGEORGIA MEDICAID AT CHILDRENS MEDICAL CENTER
GA915210274BMedicaid
GAPOO135579OtherRAILROAD MEDICARE
GA550789920OtherTRICARE