Provider Demographics
NPI:1144437799
Name:ALLIANCE MEDICAL CENTER, P.C.
Entity type:Organization
Organization Name:ALLIANCE MEDICAL CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ARNEL
Authorized Official - Last Name:RAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:770-888-2733
Mailing Address - Street 1:610 PEACHTREE PKWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-9783
Mailing Address - Country:US
Mailing Address - Phone:770-888-2733
Mailing Address - Fax:770-888-2741
Practice Address - Street 1:610 PEACHTREE PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-9783
Practice Address - Country:US
Practice Address - Phone:770-888-2733
Practice Address - Fax:770-888-2741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0336822083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD38576Medicare UPIN