Healthcare Provider Details

I. General information

NPI: 1548125024
Provider Name (Legal Business Name): ELSIE ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 CHASEBROOK DR
POWDER SPRINGS GA
30127-1079
US

IV. Provider business mailing address

269 MARKET PLACE BLVD # 134
CARTERSVILLE GA
30121-2235
US

V. Phone/Fax

Practice location:
  • Phone: 404-285-0150
  • Fax:
Mailing address:
  • Phone: 404-285-0150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberPHCP043660
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberPHCP043660
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: