Provider Demographics
NPI:1407977705
Name:ALLEN, BETH ANN (NP)
Entity Type:Individual
Prefix:MISS
First Name:BETH
Middle Name:ANN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:45 KINGTON LN
Mailing Address - Street 2:
Mailing Address - City:LOOKOUT MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30750-3152
Mailing Address - Country:US
Mailing Address - Phone:706-820-1515
Mailing Address - Fax:706-861-6088
Practice Address - Street 1:201 THOMAS RD
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-3659
Practice Address - Country:US
Practice Address - Phone:706-861-6668
Practice Address - Fax:706-861-6088
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN081047261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty