Individual
KHADIJATU E ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
204 E 15TH ST, ALMA, GA 31510
(912) 632-2952
(912) 632-8682
Mailing address
204 E 15TH ST, ALMA, GA 31510-2908
(912) 632-2952
(912) 632-8682
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
44669
GA
207R00000X
Internal Medicine Physician
Primary
44669
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00963344B
—
GA
05
—
051722401
—
FL
Enumeration date
05/26/2006
Last updated
06/15/2018
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