Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 57953 | GA |
NPI | 1598866790 |
---|---|
Provider Name | Dr. Allen R Dennis JR. |
First Address | Atlanta, GA 30339-2041 |
Second Address | Metairie, LA 70002-1623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 30/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1573078 | (05) | LA |
H20620 | (02) | LA |