Individual
ROOSEVELT ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 MEDICAL CENTER BLVD, SUITE 220, LAWRENCEVILLE, GA 30046
(770) 963-2451
(770) 962-0017
Mailing address
1930 BRANNAN RD, MCDONOUGH, GA 30253-4310
(678) 284-4040
(678) 284-4076
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
036083
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
340015405
RAILROAD MEDICARE
GA
Enumeration date
08/13/2006
Last updated
03/07/2023
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