Provider Demographics
NPI:1013458918
Name:ALLEN, TURQUOISE
Entity Type:Individual
Prefix:
First Name:TURQUOISE
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 1:1506 KLONDIKE RD SW STE 403
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-5173
Mailing Address - Country:US
Mailing Address - Phone:770-285-6699
Mailing Address - Fax:770-285-6510
Practice Address - Street 1:1506 KLONDIKE RD SW STE 403
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5173
Practice Address - Country:US
Practice Address - Phone:770-285-6699
Practice Address - Fax:770-285-6510
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN214083363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health