Healthcare Provider Details

I. General information

NPI: 1083968648
Provider Name (Legal Business Name): ALLYSON MAINS LANCASTER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLYSON MAINS RODGERS NP

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 KEITH DR
PERRY GA
31069-2947
US

IV. Provider business mailing address

1040 KEITH DR
PERRY GA
31069-2947
US

V. Phone/Fax

Practice location:
  • Phone: 478-988-1515
  • Fax: 478-313-4015
Mailing address:
  • Phone: 478-988-1515
  • Fax: 478-313-4015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN224906
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: