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Individual

DR. IDI ALLEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
101 YORKTOWN DR STE 211, FAYETTEVILLE, GA 30214-1578
(470) 481-2020
Mailing address
101 YORKTOWN DR STE 211, FAYETTEVILLE, GA 30214-1578
(470) 481-2020
(770) 703-4989

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
70849
GA
207LP3000X
Pediatric Anesthesiology Physician
70849
GA
208VP0000X
Pain Medicine Physician
70849
GA
208VP0014X
Interventional Pain Medicine Physician
Primary
70849
GA

Other

Enumeration date
04/09/2009
Last updated
03/21/2019
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