DR. IDI ALLEN (NPI# 1700029402) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700029402 |
| Entity Type | Individual |
| Full Name | DR. IDI ALLEN |
| Credential | M.D. |
| Practice Address |
101 Yorktown Dr Ste 211 Fayetteville GA 30214-1578 |
| Practice Telephone | 4704812020 |
| Mailing Telephone | 4704812020 |
| Mailing Fax Number | 7707034989 |
| Enumeration Date | 2009-04-09 |
| Last Update Date | 2019-03-21 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207L00000X | Anesthesiology | 70849 | GA | Allopathic & Osteopathic Physicians |
| N | 208VP0000X |
Pain Medicine Specialization: Pain Medicine |
70849 | GA | Allopathic & Osteopathic Physicians |
| Y | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
70849 | GA | Allopathic & Osteopathic Physicians |
| N | 207LP3000X |
Anesthesiology Specialization: Pediatric Anesthesiology |
70849 | GA | Allopathic & Osteopathic Physicians |
| Street Address |
101 YORKTOWN DR STE 211 |
| City | FAYETTEVILLE |
| State | GA |
| Zip Code | 30214-1578 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942693478 | Relief Anesthesia Solutions LLC | Clinic/Center | 101 Yorktown Dr Ste 211, Fayetteville, GA 30214-1578 | 2015-03-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548872468 | Phyllis Kelly Wood | Nurse Practitioner | 217 Banks Rd, Suite 31, Fayetteville, GA 30214 | 2020-08-21 |
| 1073139317 | Tyisha Salter Scott | Counselor | 110 Habersham Drive, Suite 142, Fayetteville, GA 30214 | 2020-06-23 |
| 1194341412 | Camille Franncine Bolton | Physical Therapist | 500 Floy Farr Parkway, Suite 303, Fayetteville, GA 30214 | 2020-06-23 |
| 1205465895 | Gillian Vaughan Heard | Physician Assistant | 1275 Ga-54 #201, Fayetteville, GA 30214 | 2020-04-06 |
| 1881234557 | Peach Fits,inc | Mastectomy Fitter | 285 Glynn Street South, Suites 102 and 104, Fayetteville, GA 30214 | 2020-01-10 |
| 1255981072 | Delta Healthcare Providers | Clinic/Center | 1275 W Lanier Ave, #200, Fayetteville, GA 30214 | 2019-09-13 |
| 1861965592 | Hierarchy for Wellness | Specialist | 805 S Glynn St Bldg 127 142, Fayetteville, GA 30214 | 2019-01-04 |
| 1356810634 | Fayette Dental Group PC | Clinic/Center | 720 W Lanier Ave, Fayetteville, GA 30214 | 2018-11-16 |
| 1891263299 | Mattie Mae Farmer Clark | Specialist/Technologist, Other | Piedmont Fayette Hospital, 1255 Highway 54 West, Fayetteville, GA 30214 | 2018-11-05 |
| 1093293607 | Allyson Holland | Pharmacist | 880 Highway 85 South, Fayetteville, GA 30214 | 2018-08-06 |
| Find all providers in zip 30214 | ||||
| Taxonomy Code | 208VP0014X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pain Medicine |
| Specialization | Interventional Pain Medicine |
| Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578193355 | Regenerative Spine and Pain Specialists | Pain Medicine | 874 Lanier Ave W Ste 250, Fayetteville, GA 30214-7662 | 2020-01-22 |
| 1295032407 | Interventional Pain Specialists of Nwa, Pllc | Pain Medicine | 509 E Millsap Rd Ste 109, Fayetteville, AR 72703-4862 | 2011-02-24 |
| 1063628675 | Southside Medical & Physical Therapy, LLC | Pain Medicine | 1415 Highway 85 N, Suite 310-314, Fayetteville, GA 30214-4035 | 2007-05-14 |
| 1104806702 | Robert David Cannon | Pain Medicine | 3715 N Business Dr, Suite #101, Fayetteville, AR 72703-5204 | 2006-01-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891302998 | Apollo Spine and Pain Center | Pain Medicine | 4415 Front Nine Dr, Cumming, GA 30041-6063 | 2020-09-23 |
| 1235756792 | Interventional Spine and Pain Management Center, PC | Pain Medicine | 2100 Central Ave Ste 6, Augusta, GA 30904-6709 | 2020-07-01 |
| 1902433147 | Sun Pain Institute LLC | Pain Medicine | 836 E 65th St Ste 38, Savannah, GA 31405-4495 | 2020-03-26 |
| 1679107338 | Atlanta Interventional Pain Management, LLC | Pain Medicine | 13190 Highway 92 Ste 120, Woodstock, GA 30188-4406 | 2020-03-02 |
| 1437790839 | Specialty Spine and Pain, PC | Pain Medicine | 1498 Jesse Jewell Pkwy Se Ste D, Gainesville, GA 30501-3874 | 2019-10-07 |
| 1154962165 | Specialty Spine and Pain, PC | Pain Medicine | 2695 Old Winder Hwy Ste 150, Braselton, GA 30517-6076 | 2019-10-01 |
| 1659912665 | Specialty Spine and Pain, PC | Pain Medicine | 5005a Lanier Islands Pkwy Ste 100, Buford, GA 30518-1802 | 2019-10-01 |
| 1114578515 | Interventional Spine and Pain Management Center, PC | Pain Medicine | 6002 Highway 53 E Ste 110, Dawsonville, GA 30534-6227 | 2019-09-26 |
| 1477106771 | Spine Center of Southeast Georgia LLC | Pain Medicine | 52a Lindsey Lane, Kingsland, GA 31548-6855 | 2019-07-17 |
| 1467014936 | Interventional Spine and Pain Management Center, PC | Pain Medicine | 6920 Mcginnis Ferry Rd Ste 360b, Suwanee, GA 30024-6672 | 2019-07-03 |
| Find all providers with the same taxonomy | ||||
| City | FAYETTEVILLE |
| Zip Code | 30214 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.