Provider Demographics
NPI:1407109267
Name:ALLEN, TERRIE HATTIE (FNP-C,PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:TERRIE
Middle Name:HATTIE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:FNP-C,PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7930 HIGHWAY 85 STE B
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-3902
Mailing Address - Country:US
Mailing Address - Phone:404-827-8971
Mailing Address - Fax:470-236-0451
Practice Address - Street 1:7930 HIGHWAY 85 STE B
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-3902
Practice Address - Country:US
Practice Address - Phone:404-827-8971
Practice Address - Fax:470-236-0451
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN195025363LF0000X
GANCO-000001363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003137406DMedicaid