Healthcare Provider Details

I. General information

NPI: 1861762007
Provider Name (Legal Business Name): ALLIED HEALTH SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 S MAIN ST
HINESVILLE GA
31313-4353
US

IV. Provider business mailing address

455 S MAIN ST STE 103
HINESVILLE GA
31313-4354
US

V. Phone/Fax

Practice location:
  • Phone: 912-876-6868
  • Fax: 912-876-6566
Mailing address:
  • Phone: 912-408-6868
  • Fax: 919-238-4528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: AMY BURNEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 919-639-8308