Provider Demographics
NPI:1013031970
Name:WEBSTER, ALVIN H (MD)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:H
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6522 PEACOCK BLVD
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-2520
Mailing Address - Country:US
Mailing Address - Phone:678-778-4591
Mailing Address - Fax:770-961-0056
Practice Address - Street 1:6522 PEACOCK BLVD
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-2520
Practice Address - Country:US
Practice Address - Phone:678-778-4591
Practice Address - Fax:770-961-0056
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042767207Q00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology