Provider Demographics
NPI:1891200127
Name:PALMER, ALLISON CONWAY (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:CONWAY
Last Name:PALMER
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:ALLIE
Other - Middle Name:
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LAT, ATC
Mailing Address - Street 1:1230B BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601-1754
Mailing Address - Country:US
Mailing Address - Phone:706-621-9450
Mailing Address - Fax:
Practice Address - Street 1:350 S MILLEDGE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605
Practice Address - Country:US
Practice Address - Phone:706-621-9450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-08
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL45582255A2300X
GAAT0034102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer