Healthcare Provider Details

I. General information

NPI: 1699967851
Provider Name (Legal Business Name): ALRENE M ALLEN-MARTIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 WESTRIDGE PKWY SUITE # 208
MCDONOUGH GA
30253-3049
US

IV. Provider business mailing address

155 WESTRIDGE PKWY SUITE #208
MCDONOUGH GA
30253-3049
US

V. Phone/Fax

Practice location:
  • Phone: 678-687-7152
  • Fax: 678-509-8103
Mailing address:
  • Phone: 678-687-7152
  • Fax: 678-509-8103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number149168
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number149168
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number149168
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number149168
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number149168
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: