Healthcare Provider Details

I. General information

NPI: 1619529393
Provider Name (Legal Business Name): CHRISTINA MAE ALLEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2648 HIGHWAY 129 N
CLEVELAND GA
30528-2710
US

IV. Provider business mailing address

170 GRANT RD W
DAWSONVILLE GA
30534-6251
US

V. Phone/Fax

Practice location:
  • Phone: 706-725-4000
  • Fax:
Mailing address:
  • Phone: 770-843-4494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN191127
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License NumberRN191127
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: