Provider Demographics
NPI:1023194784
Name:SERMONS, ALVIN L (MD)
Entity Type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:L
Last Name:SERMONS
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 1:1829 INDEPENDENCE SQ
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5151
Mailing Address - Country:US
Mailing Address - Phone:770-551-9616
Mailing Address - Fax:770-394-3647
Practice Address - Street 1:1829 INDEPENDENCE SQ
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-5151
Practice Address - Country:US
Practice Address - Phone:770-551-9616
Practice Address - Fax:770-394-3647
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026933207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00375636DMedicaid
GAF08974Medicare UPIN
GA16BDBFZMedicare ID - Type Unspecified