Provider Demographics
NPI:1104803915
Name:DUNSON-ALLEN, SHELLEY MONIQUE (MD)
Entity type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:MONIQUE
Last Name:DUNSON-ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 UPPER HEMBREE RD
Mailing Address - Street 2:BUILDING 100, SUITE D
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-0927
Mailing Address - Country:US
Mailing Address - Phone:770-670-6170
Mailing Address - Fax:770-670-6171
Practice Address - Street 1:1300 UPPER HEMBREE RD
Practice Address - Street 2:BUILDING 100, SUITE D
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-0927
Practice Address - Country:US
Practice Address - Phone:770-670-6170
Practice Address - Fax:770-670-6171
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033316174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
202G701095OtherMEDICARE PTAN
GA00544508GMedicaid
GA00544508GMedicaid