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1922002815

NPI Code Detail

MEDICARE: DR. JOHN ALEX ALLEN MD

MEDICARE: DR. JOHN ALEX 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	2084P0800X	Psychiatry Physician	27598	SC
2	2084P0804X	Child & Adolescent Psychiatry Physician	27598	SC
3	2084P0804X	Child & Adolescent Psychiatry Physician	052330	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AA77689636	OTHER	SC	MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1922002815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ALEX ALLEN MD

Provider Business Mailing Address
First Line	:	709 BREEDLOVE DR
Second Line	:
City	:	MONROE
State	:	GA
Zip	:	30655-2055
Country	:	US
Telephone Number	:	678-635-3500
Fax Number	:

Provider Business Practice Location Address
First Line	:	709 BREEDLOVE DR
Second Line	:
City	:	MONROE
State	:	GA
Zip	:	30655-2055
Country	:	US
Telephone Number	:	678-635-3500
Fax Number	:

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	07/08/2024

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Directions to “ DR. JOHN ALEX ALLEN MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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