Provider Demographics
NPI:1225086192
Name:ALBERT, TIMOTHY STEPHEN E (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:STEPHEN E
Last Name:ALBERT
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 1:119 AMBULANCE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3857
Mailing Address - Country:US
Mailing Address - Phone:770-838-8710
Mailing Address - Fax:
Practice Address - Street 1:705 DIXIE ST
Practice Address - Street 2:SUITE 401
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3818
Practice Address - Country:US
Practice Address - Phone:770-836-9326
Practice Address - Fax:770-836-9358
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94873207RC0000X
GA074262207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00422415OtherRAILROAD MEDICARE
CAA00094873OtherBLUE CROSS OF CALIFORNIA
CA00A948730Medicaid
CAA00094873OtherBLUE CROSS OF CALIFORNIA
CAH79783Medicare UPIN
CA00A948731Medicare PIN