Provider Demographics
NPI:1023803087
Name:SMITH, ALLEN G
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:G
Last Name:SMITH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3388 IN BLOOM WAY
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30011-2551
Mailing Address - Country:US
Mailing Address - Phone:917-995-2718
Mailing Address - Fax:
Practice Address - Street 1:3388 IN BLOOM WAY
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:GA
Practice Address - Zip Code:30011-2551
Practice Address - Country:US
Practice Address - Phone:917-995-2718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA25041817343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)