Provider Demographics
NPI:1922002815
Name:ALLEN, JOHN ALEX (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALEX
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 BREEDLOVE DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-2055
Mailing Address - Country:US
Mailing Address - Phone:678-635-3500
Mailing Address - Fax:
Practice Address - Street 1:709 BREEDLOVE DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2055
Practice Address - Country:US
Practice Address - Phone:678-635-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC275982084P0800X, 2084P0804X
GA0523302084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA77689636OtherMEDICARE
GA003142497DMedicaid
SC275981Medicaid
GA052330Medicaid