Basic Information
| Provider Information | |||||||||
| NPI: | 1982774527 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STUBBS | ||||||||
| FirstName: | ALLISON | ||||||||
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| Credential: | CPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 625 BIG SHANTY RD NW | ||||||||
| Address2: | |||||||||
| City: | KENNESAW | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301443646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047858010 | ||||||||
| FaxNumber: | 4047858090 | ||||||||
| Practice Location | |||||||||
| Address1: | 625 BIG SHANTY RD NW | ||||||||
| Address2: | |||||||||
| City: | KENNESAW | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301443646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047858010 | ||||||||
| FaxNumber: | 4047858090 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 06/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | RN135494 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.