Provider Demographics
NPI:1093742694
Name:MORIN, ALEXANDRE (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRE
Middle Name:
Last Name:MORIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 MAPLE ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3230
Mailing Address - Country:US
Mailing Address - Phone:770-834-0751
Mailing Address - Fax:770-834-0753
Practice Address - Street 1:119 MAPLE ST
Practice Address - Street 2:SUITE 205
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3230
Practice Address - Country:US
Practice Address - Phone:770-834-0751
Practice Address - Fax:770-834-0753
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA594742085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA635952427AMedicaid
GAH86950Medicare UPIN
GA30BDNWHMedicare PIN