Provider Demographics
NPI:1245939016
Name:ALLISON, COLTEN MATTHEW (CRNA)
Entity type:Individual
Prefix:DR
First Name:COLTEN
Middle Name:MATTHEW
Last Name:ALLISON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 MOUNTAIN BROOK RD
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-4410
Mailing Address - Country:US
Mailing Address - Phone:706-265-1888
Mailing Address - Fax:
Practice Address - Street 1:179 MOUNTAIN BROOK RD
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-4410
Practice Address - Country:US
Practice Address - Phone:706-265-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN264687367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered