=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780203547
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL LAMAR ALLEN JR. MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2020
-----------------------------------------------------
Last Update Date | 03/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4106 COLUMBIA RD STE 103
-----------------------------------------------------
City | MARTINEZ
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30907-1482
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-863-1440
-----------------------------------------------------
Fax | 706-863-5418
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4106 COLUMBIA RD STE 103
-----------------------------------------------------
City | MARTINEZ
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30907-1482
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-863-1440
-----------------------------------------------------
Fax | 706-863-5418
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 95930
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------