Provider Demographics
NPI:1346755998
Name:ALLEN SURGICAL LLC
Entity Type:Organization
Organization Name:ALLEN SURGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO- OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:404-731-9408
Mailing Address - Street 1:3689 MOUNTAIN RD NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-2411
Mailing Address - Country:US
Mailing Address - Phone:404-731-9408
Mailing Address - Fax:770-321-0520
Practice Address - Street 1:3689 MOUNTAIN RD NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-2411
Practice Address - Country:US
Practice Address - Phone:404-731-9408
Practice Address - Fax:770-321-0520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN085201363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty