Provider Demographics
NPI:1457654899
Name:MENKE, ALLISON JOY ANDERS (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:JOY ANDERS
Last Name:MENKE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 VILLAGE PARK DR
Mailing Address - Street 2:STE 103
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-3755
Mailing Address - Country:US
Mailing Address - Phone:706-999-9994
Mailing Address - Fax:
Practice Address - Street 1:1031 VILLAGE PARK DR
Practice Address - Street 2:STE 103
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-3755
Practice Address - Country:US
Practice Address - Phone:706-999-9994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001138213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52593148OtherBCBS
GA202I487829Medicare PIN