Provider Demographics
NPI:1598866790
Name:DENNIS, ALLEN R JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:R
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 1:1800 WATER PL SE STE 100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2041
Mailing Address - Country:US
Mailing Address - Phone:770-801-0980
Mailing Address - Fax:770-801-9039
Practice Address - Street 1:3223 8TH ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-1623
Practice Address - Country:US
Practice Address - Phone:504-833-7770
Practice Address - Fax:504-833-7796
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA57953207RA0401X
LAMD.024508207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1573078Medicaid
LA5H470Medicare ID - Type Unspecified
LA1573078Medicaid