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General NPI Number Information
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NPI Number | 1427077759
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Entity Type | Individual
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Provider Name | MARY JUDITH ALLEN D.O.
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Gender | Female
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 10/01/2019
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Provider Practice Location Address
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Address Line | 303 FRASER DR
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City | HINESVILLE
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State | GA
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Zip | 31313-3712
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Country | US
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Telephone | 912-877-2227
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Fax | 912-877-2332
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Provider Business Mailing Address
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Address Line | 13592 WAYNESFIELD RD
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City | WAPAKONETA
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State | OH
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Zip | 45895-8621
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Country | US
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Telephone | 419-305-5728
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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 | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 51615
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License Number State | GA
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