Provider Demographics
NPI:1790872158
Name:ALLEN, RENAI (DNP, APRN)
Entity type:Individual
Prefix:
First Name:RENAI
Middle Name:
Last Name:ALLEN
Suffix:
Gender:
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 PARKER RD SE STE C210
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-6676
Mailing Address - Country:US
Mailing Address - Phone:617-699-5013
Mailing Address - Fax:
Practice Address - Street 1:3255 N POINT PKWY STE 202
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4712
Practice Address - Country:US
Practice Address - Phone:617-699-5013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN222518363LF0000X
MA260064363LF0000X
WAAP61079012363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA222518OtherGA BORN LICENSE
NH063977-23OtherNH BORN
MA260064OtherMASS BORM LICENSE
FLAPRN11006495OtherFL BORN