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General NPI Number Information
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NPI Number | 1164926267
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Entity Type | Individual
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Provider Name | GABRIELLE MARIE DE ALLIE MD
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Gender | Female
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Dates
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Enumeration Date | 03/22/2018
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Last Update Date | 06/06/2022
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Provider Practice Location Address
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Address Line | 5000 KY ROUTE 321 STE 3141
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City | PRESTONSBURG
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State | KY
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Zip | 41653-9113
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Country | US
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Telephone | 606-886-8511
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Fax | 606-886-1316
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Provider Business Mailing Address
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Address Line | 2771 FARMSTEAD CT
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City | GRAYSON
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State | GA
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Zip | 30017-1511
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Country | US
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Telephone | 347-295-8770
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 88990
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | TP707
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License Number State | KY
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