Healthcare Provider Details

I. General information

NPI: 1750297305
Provider Name (Legal Business Name): MOLLY KATE ALLEN CNIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOLLY KATE ARD

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 NORTHSIDE DR
MACON GA
31210-2404
US

IV. Provider business mailing address

624 PLUM ST STE A
MACON GA
31201-2811
US

V. Phone/Fax

Practice location:
  • Phone: 478-745-4206
  • Fax:
Mailing address:
  • Phone: 478-273-3831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: