Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 029570 | GA |
NPI | 1174583231 |
---|---|
Provider Name | Mr. Joel J Alexander |
First Address | Alpharetta, GA 30005-5211 |
Second Address | Atlanta, GA 30339-2228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 22/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000346442A | (05) | GA |
D44697 | (02) | GA |