Provider Demographics
NPI:1801655386
Name:ALLEN, LAVISTA NECHON
Entity type:Individual
Prefix:
First Name:LAVISTA
Middle Name:NECHON
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 1:746 SWEETBRIAR CIR
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-7013
Mailing Address - Country:US
Mailing Address - Phone:478-957-5132
Mailing Address - Fax:
Practice Address - Street 1:746 SWEETBRIAR CIR
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-7013
Practice Address - Country:US
Practice Address - Phone:478-957-5132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)