1891701496 NPI number — DR. CORRIE VANEXEL ALFORD M.D.

Table of content: DR. CORRIE VANEXEL ALFORD M.D. (NPI 1891701496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891701496 NPI number — DR. CORRIE VANEXEL ALFORD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALFORD
Provider First Name:
CORRIE
Provider Middle Name:
VANEXEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALFORD
Provider Other First Name:
CORRIE
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891701496
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
148 BILL CARRUTH PKWY.
Provider Second Line Business Mailing Address:
SUITE 280
Provider Business Mailing Address City Name:
HIRAM
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-363-3343
Provider Business Mailing Address Fax Number:
678-363-3380

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
148 BILL CARRUTH PKWY.
Provider Second Line Business Practice Location Address:
SUITE 280
Provider Business Practice Location Address City Name:
HIRAM
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-363-3343
Provider Business Practice Location Address Fax Number:
678-363-3380
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  57567 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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