MEDICARE: MR. PAUL E. L ALLEN SR. MD

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	207P00000X	Emergency Medicine Physician	028490	GA
2	207Q00000X	Family Medicine Physician	028490	GA
3	207R00000X	Internal Medicine Physician	028490	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417990334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL E. L ALLEN SR. MD

Provider Business Mailing Address
First Line	:	2795 MAIN ST W # 27
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-3164
Country	:	US
Telephone Number	:	770-985-8001
Fax Number	:

Provider Business Practice Location Address
First Line	:	2795 MAIN ST W # 27
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-3164
Country	:	US
Telephone Number	:	770-985-8001
Fax Number	:

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	07/22/2019

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