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Individual

ALLEN TERENCE RAPHAEL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.P.M.

Contact information

Practice address
3200 HIGHLANDS PARKWAY, SUITE 100, SMYRNA, GA 30082-5196
(770) 319-5502
(770) 434-9010
Mailing address
900 CIRCLE 75 PKWY. SE, SUITE 200, ATLANTA, GA 30080-3084
(678) 426-2171
(404) 446-1957

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
POD001050
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
52212173-001
BC/BS, SMYRNA
GA
01
52212173-002
BC/BS DOUGLASVILLE
GA
01
5284933
CIGNA
GA
01
581994261
GREAT WEST HEALTHCARE
GA
05
761921467A
GA
05
761921467C
GA
05
761921467G
GA
05
761921467J
GA
05
761921467P
GA
01
946888
BLUE CROSS BLUE SHIELD GA
GA
Enumeration date
05/26/2006
Last updated
10/15/2018
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