Provider Demographics
NPI:1811964547
Name:ALLEN, STEPHANIE A (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:A
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5780 PEACHTREE DUNWOODY ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1513
Mailing Address - Country:US
Mailing Address - Phone:404-303-1224
Mailing Address - Fax:404-303-1325
Practice Address - Street 1:355 HAWTHORNE LN
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2153
Practice Address - Country:US
Practice Address - Phone:706-369-0019
Practice Address - Fax:706-369-1989
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2013-08-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA050090207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000911732EMedicaid
GAH26589Medicare UPIN
GA16BBBXFMedicare ID - Type Unspecified