Healthcare Provider Details

I. General information

NPI: 1982320875
Provider Name (Legal Business Name): ALLIE HOWARD PALMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 HARPER ST FL 5
AUGUSTA GA
30912-0012
US

IV. Provider business mailing address

1120 15TH ST
AUGUSTA GA
30912-0004
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-1567
  • Fax: 706-721-6676
Mailing address:
  • Phone: 706-721-2286
  • Fax: 706-721-8638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN236050
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN236050
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: