Individual
MR. MICHAEL M. ALLEN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2104 MAIN ST STE 13, PORTERDALE, GA 30014-3438
(678) 972-6944
Mailing address
2104 MAIN ST STE 13, PORTERDALE, GA 30014-3438
(678) 972-6944
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
BR018475
GA
332BC3200X
Customized Equipment (DME)
Primary
BR018475
GA
335E00000X
Prosthetic/Orthotic Supplier
BR018475
GA
Other
Enumeration date
04/22/2026
Last updated
04/29/2026
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