Provider Demographics
NPI:1649462896
Name:ALLAN, KATHY STUKES (MD)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:STUKES
Last Name:ALLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 FERST DRIVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30332-0470
Mailing Address - Country:US
Mailing Address - Phone:404-894-1424
Mailing Address - Fax:404-385-0717
Practice Address - Street 1:740 FERST DRIVE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30332-0470
Practice Address - Country:US
Practice Address - Phone:404-894-1429
Practice Address - Fax:404-385-0717
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA34959207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00479135AMedicaid
GA34959OtherGA LICENCE NUMBER
GABS1928590OtherDEA
GAE20864Medicare UPIN