Provider Demographics
NPI:1508904038
Name:ALLEN, BARBARA B (WHNP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:B
Last Name:ALLEN
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 UNIVETER RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-8261
Mailing Address - Country:US
Mailing Address - Phone:770-234-7371
Mailing Address - Fax:770-345-6978
Practice Address - Street 1:1219 UNIVETER RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-8261
Practice Address - Country:US
Practice Address - Phone:770-234-7371
Practice Address - Fax:770-345-6978
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN092929363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00784561AMedicaid