Provider Demographics
NPI:1871167098
Name:ALLEN, MICHAELA ALEXUS (PA)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:ALEXUS
Last Name:ALLEN
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:ALEXUS
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3225 CUMBERLAND BLVD SE STE 520
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6407
Mailing Address - Country:US
Mailing Address - Phone:678-915-2000
Mailing Address - Fax:404-868-3363
Practice Address - Street 1:1035 SOUTHCREST DR STE AND250
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6118
Practice Address - Country:US
Practice Address - Phone:678-915-2000
Practice Address - Fax:404-868-3363
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant