Andrea L Allyn, M.D.
Individual provider Active NPI Internal Medicine Physician · Seneca, SC
NPI 1851363733 · NPPES record last updated Jul 23, 2014
Key facts
- NPI
- 1851363733
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 30703 (SC)
- Practice address
- 10110 Clemson Blvd
Seneca, SC 29678-0812 - Phone
- (864) 482-0500
- Fax
- (864) 482-0505
- NPI assigned
- Feb 3, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- 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 |
|---|---|---|---|---|
| I20150317002343 | GA | Practitioner - Internal Medicine | 1456421338 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021233 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellstar Medical Group, LLC | Current | Accepting new patients | |
| Wellstar Medical Group, LLC | Current |
Accepting new patients | |
| Wellstar Medical Group, LLC | Internal Medicine | Current |
Accepting new patients |
Locations
5150 Stilesboro Rd NW
Ste 120
Kennesaw, GA 30152
Phone (678) 354-0230
5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222
54 Tower Rd NE
Marietta, GA 30060
Phone (770) 427-4682
Interoperability endpoints
- andrea.allyn.1@21043.direct.athenahealth.com
- aallyn94905@directwellstar.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 30703 | SC | Yes |
Addresses
Primary practice location
10110 Clemson Blvd
Seneca, SC 29678-0812
Mailing address
PO Box 601082
Charlotte, NC 28260-1082
Phone (864) 885-7989
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AA2717 | Other | SC | MEDICARE PTAN |
| 000222285E | Medicaid | GA | |
| 1851363733 | Medicaid | SC |
Other providers in Seneca, SC
- Ali'S Fine Lingerie, LLC
- Martin Augustus Allen
- Robert Stanley Allen
- Tamira Allen
- Kiran Kumar Allu
- Alexis Almeida
- Xavier Alston
- Fredrick Michael Amatriain
- American Medical Consultants, LLC
- Anderson Diagnostic Imaging, Inc
All providers in Seneca, SC · Internal Medicine Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 23, 2014. 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.