Provider Demographics
NPI:1235633645
Name:GILMORE, ALEXANDER MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:MATTHEW
Last Name:GILMORE
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 1:101 MANNING DR # 7231
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4220
Mailing Address - Country:US
Mailing Address - Phone:919-962-5136
Mailing Address - Fax:919-962-4421
Practice Address - Street 1:100 OLD BALL GROUND HWY STE B
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2890
Practice Address - Country:US
Practice Address - Phone:770-720-8000
Practice Address - Fax:787-440-2596
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC390200000X
GA94584207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program