Provider Demographics
NPI:1437355724
Name:DENNIS, ALLEN JOHNSON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:JOHNSON
Last Name:DENNIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 MONTROSE CT
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4353
Mailing Address - Country:US
Mailing Address - Phone:706-736-8527
Mailing Address - Fax:
Practice Address - Street 1:715 MONTROSE CT
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4353
Practice Address - Country:US
Practice Address - Phone:706-736-8527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10373207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD39728Medicare UPIN