Provider Demographics
NPI:1285814293
Name:THOMAS M. ALLEN M.D., LLC
Entity Type:Organization
Organization Name:THOMAS M. ALLEN M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:912-538-5508
Mailing Address - Street 1:500 MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-8998
Mailing Address - Country:US
Mailing Address - Phone:912-537-1815
Mailing Address - Fax:912-537-9557
Practice Address - Street 1:500 MAPLE DR
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-8998
Practice Address - Country:US
Practice Address - Phone:912-537-1815
Practice Address - Fax:912-537-9557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty