Provider Demographics
NPI:1003975574
Name:ALLIANCE HEALTH GROUP LLC
Entity Type:Organization
Organization Name:ALLIANCE HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDO
Authorized Official - Middle Name:
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-714-5722
Mailing Address - Street 1:3320 LAWRENCEVILLE SUWANEE ROAD
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024
Mailing Address - Country:US
Mailing Address - Phone:678-714-5722
Mailing Address - Fax:678-714-5724
Practice Address - Street 1:3320 LAWRENCEVILLE SUWANEE ROAD
Practice Address - Street 2:SUITE 1C
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024
Practice Address - Country:US
Practice Address - Phone:678-714-5722
Practice Address - Fax:678-714-5724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO007116111N00000X
GACHIRO006264111N00000X
GAGA6920207XS0114X
GAGA11414225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty