Individual provider Active NPI

Courtney Allen, D.O.

  • Pediatrics Physician
  • Atlanta, GA
National Provider Identifier
1710322144
Registry record updated Sep 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
075593 Issued in GA
Practice address
1645 Tullie Cir NE
Atlanta, GA 30329-2304
Phone
(772) 888-5856
NPI assigned
Apr 29, 2013
Last updated
Sep 7, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 075593 GA Primary

Addresses

Primary practice location

1645 Tullie Cir NE
Atlanta, GA 30329-2304

Mailing address

1645 Tullie Cir NE
Atlanta, GA 30329-2304
Phone (772) 888-5856

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, FL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20191021001570 GA Practitioner - Pediatric Medicine 7012204225 Reassigns benefits to 1 organization
I20230119001168 FL Practitioner - Pediatric MedicinePractitioner - Emergency Medicine 7012204225 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Medical Associates of Tampa Bay, LLC CurrentSince Nov 1, 2022 Accepting new patients
Emergency Coverage, LLC CurrentSince Sep 1, 2019 Accepting new patients
Observation Medical Group LLC CurrentSince Mar 27, 2023 Accepting new patients
Observation Medical Group LLC CurrentSince Mar 27, 2023 Accepting new patients
Pediatric Sedation Services, LLC Past Accepting new patients

Locations

4211 Van Dyke Rd
Lutz, FL 33558
Phone (813) 443-2010

6901 Simmons Loop
Riverview, FL 33578
Phone (813) 302-8000

3001 W Mlk Blvd
Tampa, FL 33607
Phone (813) 361-6778

4501 Bruce B Downs Blvd
Zephyrhills, FL 33544
Phone (813) 870-4000

1200 Memorial Dr
Dalton, GA 30720
Phone (706) 272-6115

677 Church St NE
Marietta, GA 30060
Phone (770) 793-5435

1001 Johnson Fy Rd NE
Sandy Springs, GA 30342
Phone (404) 785-2008

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1367193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473206400000",
    "number": "1710322144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1645 TULLIE CIR NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303292304",
            "telephone_number": "772-888-5856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1645 TULLIE CIR NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303292304",
            "telephone_number": "772-888-5856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALLEN",
        "first_name": "COURTNEY",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-29",
        "last_updated": "2016-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "075593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.