Provider Demographics
NPI:1013190131
Name:ALEJANDRO F. PERNETT, M.D., P.C.
Entity Type:Organization
Organization Name:ALEJANDRO F. PERNETT, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:F
Authorized Official - Last Name:PERNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-379-9380
Mailing Address - Street 1:9 HESTER ST
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31539-6323
Mailing Address - Country:US
Mailing Address - Phone:912-379-9380
Mailing Address - Fax:912-379-9382
Practice Address - Street 1:9 HESTER ST
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:GA
Practice Address - Zip Code:31539-6323
Practice Address - Country:US
Practice Address - Phone:912-379-9380
Practice Address - Fax:912-379-9382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029928208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00379431QMedicaid
369975OtherWELLCARE
GA336264OtherWELLCARE
GA10037432OtherAMERIGROUP
369975OtherWELLCARE
GAGRP4955Medicare PIN
GAE19907Medicare UPIN