Provider Demographics
NPI:1891093860
Name:ALLEN, WILLIAM CHASE (CSA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CHASE
Last Name:ALLEN
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8025 SANDORN DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-6733
Mailing Address - Country:US
Mailing Address - Phone:321-231-6594
Mailing Address - Fax:
Practice Address - Street 1:8025 SANDORN DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-6733
Practice Address - Country:US
Practice Address - Phone:321-231-6594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3716246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant