Provider Demographics
NPI:1023030392
Name:ALEXANDER, RAYMOND THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:THOMAS
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 RIVERSIDE PKWY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5926
Mailing Address - Country:US
Mailing Address - Phone:678-407-8230
Mailing Address - Fax:678-407-8233
Practice Address - Street 1:2000 RIVERSIDE PKWY
Practice Address - Street 2:SUITE 206
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5926
Practice Address - Country:US
Practice Address - Phone:678-407-8230
Practice Address - Fax:678-407-8233
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2925111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCBHDMedicare ID - Type Unspecified
GAU25407Medicare UPIN