Provider Demographics
NPI:1871781476
Name:KEY, ALLISON KIMBALL (MD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:KIMBALL
Last Name:KEY
Suffix:
Gender:F
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:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:GA
Mailing Address - Zip Code:30110-0728
Mailing Address - Country:US
Mailing Address - Phone:770-537-1234
Mailing Address - Fax:770-537-1237
Practice Address - Street 1:PO BOX 728
Practice Address - Street 2:222 GORDON STREET
Practice Address - City:BREMEN
Practice Address - State:GA
Practice Address - Zip Code:30110
Practice Address - Country:US
Practice Address - Phone:770-537-1234
Practice Address - Fax:770-537-1235
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059986207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAAPPLIED FORMedicaid
GAAPPLIED FORMedicare PIN