Provider Demographics
NPI:1558030445
Name:BLOOM, ALLYSON CATHERINE (NP)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:CATHERINE
Last Name:BLOOM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6894 LANCASTER XING
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-7627
Mailing Address - Country:US
Mailing Address - Phone:404-451-2142
Mailing Address - Fax:
Practice Address - Street 1:2323 CHESHIRE BRIDGE RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3725
Practice Address - Country:US
Practice Address - Phone:310-429-8835
Practice Address - Fax:843-936-1787
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN209509363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily