MEDICARE: DR. ASHLEY NIX ALLEN 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	207Q00000X	Family Medicine Physician	036122515	IL
2	207Q00000X	Family Medicine Physician	2011-01916	NC
3	207Q00000X	Family Medicine Physician	36702	SC

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
2	170RU	OTHER	NC	BCBSNC

General Provider Information

NPI Number	:	1720244411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHLEY NIX ALLEN MD

Provider Business Mailing Address
First Line	:	2000 PERIMETER PARK DR STE 200
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-8442
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5070 INTERNATIONAL BLVD
Second Line	:	SUITE 131
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29418-6006
Country	:	US
Telephone Number	:	843-763-7906
Fax Number	:	843-740-9039

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

Provider Enumeration Date	:	08/01/2008
Last Update Date	:	08/24/2021

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