Provider Demographics
NPI:1700995925
Name:ALLEYNE, CARGILL JR (MD)
Entity Type:Individual
Prefix:
First Name:CARGILL
Middle Name:
Last Name:ALLEYNE
Suffix:JR
Gender:M
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:PO BOX 1705
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-1705
Mailing Address - Country:US
Mailing Address - Phone:706-774-7226
Mailing Address - Fax:706-774-1999
Practice Address - Street 1:840 STEVENS CREEK RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-9251
Practice Address - Country:US
Practice Address - Phone:706-722-6957
Practice Address - Fax:706-722-1999
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036084207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG36084Medicaid
GA003330976AMedicaid
GA003330976AMedicaid
SCG36084Medicaid