Provider Demographics
NPI:1245847367
Name:ALLEN, MARLIN CALVIN
Entity type:Individual
Prefix:
First Name:MARLIN
Middle Name:CALVIN
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 JOYCE DR
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-2707
Mailing Address - Country:US
Mailing Address - Phone:478-697-1725
Mailing Address - Fax:
Practice Address - Street 1:1209 W WALNUT AVE STE 1
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3961
Practice Address - Country:US
Practice Address - Phone:706-459-3572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN237743363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily