Provider Demographics
NPI:1346593852
Name:ALLEYNE, MONTRESE PITMON (NP-C)
Entity Type:Individual
Prefix:
First Name:MONTRESE
Middle Name:PITMON
Last Name:ALLEYNE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 LOGAN LOOP
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-9789
Mailing Address - Country:US
Mailing Address - Phone:678-458-7222
Mailing Address - Fax:
Practice Address - Street 1:100 EAGLES WALK
Practice Address - Street 2:SUITE A
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6335
Practice Address - Country:US
Practice Address - Phone:770-506-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN155438363LF0000X
TN18800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily