Healthcare Provider Details

I. General information

NPI: 1063036150
Provider Name (Legal Business Name): JAMES MICHAEL ALLEN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 CLAIREMONT AVE STE 205
DECATUR GA
30030-2558
US

IV. Provider business mailing address

990 HAMMOND DR # 525
ATLANTA GA
30328-5529
US

V. Phone/Fax

Practice location:
  • Phone: 702-851-5237
  • Fax:
Mailing address:
  • Phone: 678-779-7153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10246
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: