Provider Demographics
NPI:1891342135
Name:ALLEN, CHAKITA MIESHA (CFA)
Entity Type:Individual
Prefix:
First Name:CHAKITA
Middle Name:MIESHA
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CFA
Other - Prefix:
Other - First Name:CHAKITA
Other - Middle Name:M
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CFA
Mailing Address - Street 1:24 HALYARD DR
Mailing Address - Street 2:
Mailing Address - City:PORT WENTWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:31407-9755
Mailing Address - Country:US
Mailing Address - Phone:912-507-0413
Mailing Address - Fax:
Practice Address - Street 1:24 HALYARD DR
Practice Address - Street 2:
Practice Address - City:PORT WENTWORTH
Practice Address - State:GA
Practice Address - Zip Code:31407-9755
Practice Address - Country:US
Practice Address - Phone:912-507-0413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA189859208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty