Basic Information
| Provider Information | |||||||||
| NPI: | 1346759974 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALLISON | ||||||||
| FirstName: | NEVA | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6085 OLD NATIONAL HWY STE G | ||||||||
| Address2: | |||||||||
| City: | SOUTH FULTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303494333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4707546360 | ||||||||
| FaxNumber: | 8777807359 | ||||||||
| Practice Location | |||||||||
| Address1: | 6085 OLD NATIONAL HWY STE G | ||||||||
| Address2: | |||||||||
| City: | SOUTH FULTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303494333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4707546360 | ||||||||
| FaxNumber: | 8777807359 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2017 | ||||||||
| LastUpdateDate: | 08/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | RN250913 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | G325565196 | 01 | GA | MEDICARE | OTHER | 003207772C | 05 | GA | MEDICAID |