Healthcare Provider Details

I. General information

NPI: 1548227424
Provider Name (Legal Business Name): JACKIE L. ALLEN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W MONTGOMERY XRD
SAVANNAH GA
31406-3309
US

IV. Provider business mailing address

11 DOLAN DR
SAVANNAH GA
31406-5201
US

V. Phone/Fax

Practice location:
  • Phone: 912-921-2001
  • Fax:
Mailing address:
  • Phone: 912-657-1455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR069517
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR069517
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberR069517
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: