Individual
MR. STANLEY BRUCE ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
2621 E PINETREE BLVD, THOMASVILLE, GA 31792-4840
(229) 584-4100
Mailing address
900 CAIRO RD, THOMASVILLE, GA 31792-4255
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001731
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100000109B
—
GA
01
—
970029019
RAILROAD MEDICARE
GA
01
—
GRP7061
MEDICARE GROUP
GA
Enumeration date
09/23/2005
Last updated
09/17/2020
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