Provider Demographics
NPI:1235178682
Name:INTERNAL MEDICINE ALLIANCE
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-495-2100
Mailing Address - Street 1:2179 NORTHLAKE PKWY
Mailing Address - Street 2:BLDGE 5 SUITE 101
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4119
Mailing Address - Country:US
Mailing Address - Phone:678-495-2100
Mailing Address - Fax:678-495-2104
Practice Address - Street 1:2179 NORTHLAKE PKWY
Practice Address - Street 2:BLGD 5 SUITE 101
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4119
Practice Address - Country:US
Practice Address - Phone:678-495-2100
Practice Address - Fax:678-495-2104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046509174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH03833Medicare UPIN
GAGRP7162Medicare ID - Type Unspecified