Provider Demographics
NPI:1447301569
Name:ALLEN, REUBEN MICHAEL (MD, PC)
Entity type:Individual
Prefix:
First Name:REUBEN
Middle Name:MICHAEL
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4015 S COBB DR SE
Mailing Address - Street 2:SUITE # 110 - B
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6303
Mailing Address - Country:US
Mailing Address - Phone:770-438-4277
Mailing Address - Fax:770-438-4297
Practice Address - Street 1:4015 SOUTH COBB DRIVE, SE
Practice Address - Street 2:SUITE # 100 - B
Practice Address - City:SMYMA
Practice Address - State:GA
Practice Address - Zip Code:33080
Practice Address - Country:US
Practice Address - Phone:770-438-4277
Practice Address - Fax:770-438-4297
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2010-09-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0456922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000823402AMedicaid
GA26BDJFZMedicare UPIN