Provider Demographics
NPI:1679055271
Name:ALLEN, SHEILA
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16935 ADEL HWY
Mailing Address - Street 2:
Mailing Address - City:BARNEY
Mailing Address - State:GA
Mailing Address - Zip Code:31625-2126
Mailing Address - Country:US
Mailing Address - Phone:229-200-8888
Mailing Address - Fax:
Practice Address - Street 1:705 HUDSON AVE
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:GA
Practice Address - Zip Code:31714-5312
Practice Address - Country:US
Practice Address - Phone:229-567-2461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADH012280124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist