Georgia Carol Allen, DO
Individual provider Active NPI Internal Medicine Physician · Vallejo, CA
NPI 1508844796 · NPPES record last updated Jun 18, 2015
Key facts
- NPI
- 1508844796
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 20A6109 (CA)
- Practice address
- 365 Tuolumne St
Vallejo, CA 94590-5700 - Phone
- (707) 553-5509
- Fax
- (707) 553-5658
- NPI assigned
- Jan 6, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090916000615 | CA | Practitioner - Internal Medicine | 5890785364 | Practice locations: National City, CA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20A6109 | CA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Timberland Medical Group | Internal Medicine | Past | Accepting new patients |
| Weatherford Inpatient Physician Association, P. a. | Internal Medicine | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | K7497 | TX | |
| Internal Medicine Physician | 207R00000X | 20A6109 | CA | Yes |
Addresses
Primary practice location
365 Tuolumne St
Vallejo, CA 94590-5700
Mailing address
1310 Club Dr
Vallejo, CA 94592-1187
Phone (707) 638-5232
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8DB606 | Other | TX | BCBS |
| 045035506 | Medicaid | TX |
Other providers in Vallejo, CA
- All Medical Supply & Equipment LLC
- Andre J Allen
- Angelina Marie Bello-Chong Allen
- Debra Allen
- Dian R Allen
- Heather Marie Allen
- Kennisha Allen
- Kimberly Marie Allen
- Myeasa Allen
- Kirsten May Alliston
All providers in Vallejo, CA · Internal Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 18, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.