Individual
JEANIE L ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTIONER
Contact information
Practice address
1006 MOUNT VERNON RD, VIDALIA, GA 30474-3029
(912) 537-1221
(912) 537-1221
Mailing address
101 HARRIS INDUSTRIAL BLVD STE A, VIDALIA, GA 30474-8852
(912) 535-3500
(912) 535-4498
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN087452
GA
363LA2200X
Adult Health Nurse Practitioner
RN087452
GA
Other
Enumeration date
08/31/2006
Last updated
05/05/2021
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