1679563423 NPI number — ALAN D PERRY M.D.

Table of content: ALAN D PERRY M.D. (NPI 1679563423)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679563423 NPI number — ALAN D PERRY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERRY
Provider First Name:
ALAN
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679563423
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
232 19TH ST NW
Provider Second Line Business Mailing Address:
SUITE 7220
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30363-1130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-367-3000
Provider Business Mailing Address Fax Number:
404-609-7628

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
232 19TH ST NW
Provider Second Line Business Practice Location Address:
SUITE 7220
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30363-1130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-367-3000
Provider Business Practice Location Address Fax Number:
404-609-7628
Provider Enumeration Date:
10/24/2005

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: 207Q00000X , with the licence number:  47990 , 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)

  • Identifier: 1104020002 . This is a "PEACHSTATE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: P00124116 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 313965 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 8708 . This is a "KAISER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 10033145 . This is a "AMERIGROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 52702796001 . This is a "BC/BS GEORGIA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000910896A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0101672 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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