Provider Demographics
NPI:1902488703
Name:ALLEN, TERRICA (PHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:TERRICA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 MORNING VW
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-5290
Mailing Address - Country:US
Mailing Address - Phone:334-441-5844
Mailing Address - Fax:
Practice Address - Street 1:4301 MORNING VW
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-5290
Practice Address - Country:US
Practice Address - Phone:334-441-5844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty
No251J00000XAgenciesNursing CareGroup - Single Specialty