Provider Demographics
NPI:1962739417
Name:ALLEN DERMATOLOGY & SKIN CANCER CTR
Entity type:Organization
Organization Name:ALLEN DERMATOLOGY & SKIN CANCER CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNDER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:HAWKINS
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-477-6700
Mailing Address - Street 1:520 CHARTER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4871
Mailing Address - Country:US
Mailing Address - Phone:478-477-6700
Mailing Address - Fax:478-757-8135
Practice Address - Street 1:520 CHARTER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-4871
Practice Address - Country:US
Practice Address - Phone:478-477-6700
Practice Address - Fax:478-757-8135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty