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General NPI Number Information
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NPI Number | 1205119005
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Entity Type | Individual
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Provider Name | IVEY E. ALLEN P.A.
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Gender | Female
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Dates
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Enumeration Date | 09/28/2011
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Last Update Date | 09/17/2020
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Provider Practice Location Address
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Address Line | 100 MIMOSA DR
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City | THOMASVILLE
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State | GA
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Zip | 31792-6676
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Country | US
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Telephone | 229-226-8881
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Fax | 229-227-5187
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Provider Business Mailing Address
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Address Line | 900 CAIRO RD
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City | THOMASVILLE
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State | GA
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Zip | 31792-4255
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Country | US
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Telephone | 229-227-5102
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Fax | 229-227-5187
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 006083
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License Number State | GA
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