Provider Demographics
NPI:1114955572
Name:JUSTICE, ALAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:D
Last Name:JUSTICE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:446 POPLAR ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-3336
Mailing Address - Country:US
Mailing Address - Phone:478-746-0097
Mailing Address - Fax:478-742-4051
Practice Address - Street 1:446 POPLAR ST
Practice Address - Street 2:SUITE B
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-3336
Practice Address - Country:US
Practice Address - Phone:478-746-0097
Practice Address - Fax:478-742-4051
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2022-06-29
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Provider Licenses
StateLicense IDTaxonomies
GA032405207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA110150410OtherRAILROAD MEDICARE
GA11BDMNZ01Medicare PIN
GAE50341Medicare UPIN