MEDICARE: DR. ANTWUAN ALLEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	7618	GA

General Provider Information

NPI Number	:	1194263624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTWUAN ALLEN

Provider Business Mailing Address
First Line	:	2336 DAWSON RD STE 2200
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31707-2801
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2336 DAWSON RD STE 2200
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31707-2801
Country	:	US
Telephone Number	:	229-312-8871
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2017
Last Update Date	:	02/03/2017

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Directions to “ DR. ANTWUAN ALLEN ” Practice Location

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