Provider Demographics
NPI:1063860740
Name:ALPHA RECOVERY GROUP INC
Entity Type:Organization
Organization Name:ALPHA RECOVERY GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:I
Authorized Official - Last Name:ALIMI
Authorized Official - Suffix:
Authorized Official - Credentials:BSC, MSC
Authorized Official - Phone:770-896-6730
Mailing Address - Street 1:3400 MCCLURE BRIDGE RD
Mailing Address - Street 2:BUILDING C, SUIT A&B
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-6675
Mailing Address - Country:US
Mailing Address - Phone:770-896-6730
Mailing Address - Fax:770-896-6730
Practice Address - Street 1:3400 MCCLURE BRIDGE RD
Practice Address - Street 2:BUILDING C, SUIT A&B
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-6675
Practice Address - Country:US
Practice Address - Phone:770-896-6730
Practice Address - Fax:770-896-6730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QM2800X, 302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAN/AOtherN/A