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Individual
MARY ALICE ALLCOTT
Active
Individual
MARY ALICE ALLCOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
RN052669
GA
363LA2200X
Adult Health Nurse Practitioner
RN052669
GA
363LF0000X
Family Nurse Practitioner
Primary
RN052669
GA
363LP2300X
Primary Care Nurse Practitioner
RN052669
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10064224
AMERIGROUP NUMBER
GA
05
—
130497891B
—
GA
01
—
348466
WELLCARE NUMBER
GA
01
—
P00228955
RAILROAD MEDICARE
GA
01
—
RN052669
GEORGIA LICENSE
GA
Enumeration date
12/29/2006
Last updated
04/22/2015
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