Provider Demographics
NPI:1699860494
Name:ALLEN, RICHARD L (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:ALLEN
Suffix:
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:PO BOX 1038
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31902-1038
Mailing Address - Country:US
Mailing Address - Phone:706-660-6410
Mailing Address - Fax:706-660-2847
Practice Address - Street 1:2000 10TH AVE
Practice Address - Street 2:SUITE 180
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3700
Practice Address - Country:US
Practice Address - Phone:706-571-1519
Practice Address - Fax:706-320-8675
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037462207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000571139AMedicaid
GAF70074Medicare UPIN
GA16BDDHQMedicare ID - Type UnspecifiedWOMENS MEDICAL
GA16BBCNDMedicare ID - Type UnspecifiedOB CLINIC