Healthcare Provider Details

I. General information

NPI: 1346444676
Provider Name (Legal Business Name): JAMES W ALLEN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JIM ALLEN CRNA

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 LAKE TEHAMA TRL
HOMER GA
30547-2250
US

IV. Provider business mailing address

182 LAKE TEHAMA TRL
HOMER GA
30547-2250
US

V. Phone/Fax

Practice location:
  • Phone: 706-677-2019
  • Fax:
Mailing address:
  • Phone: 706-677-2019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number032201
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: