Provider Demographics
NPI:1144484981
Name:VANN, ALLISON GATES (MD)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:GATES
Last Name:VANN
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 1:429 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5210
Mailing Address - Country:US
Mailing Address - Phone:256-413-6000
Mailing Address - Fax:256-413-6001
Practice Address - Street 1:429 S 3RD ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5210
Practice Address - Country:US
Practice Address - Phone:256-413-6000
Practice Address - Fax:256-413-6001
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1013671940OtherGROUP NPI
1144484981OtherNPI
AL30334OtherALABAMA BOARD OF MEDICAL EXAMINERS STATE LICENSE
AL1D120655Medicaid
FV0911203OtherDEA
1558506550OtherGROUP NPI