Provider Demographics
NPI:1326364837
Name:ALPHA CLINICS, PA
Entity Type:Organization
Organization Name:ALPHA CLINICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:AZIEGBE
Authorized Official - Last Name:AVBUERE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-358-1528
Mailing Address - Street 1:3231 YANCEYVILLE ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-4043
Mailing Address - Country:US
Mailing Address - Phone:336-358-1528
Mailing Address - Fax:336-358-1582
Practice Address - Street 1:3231 YANCEYVILLE ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-4043
Practice Address - Country:US
Practice Address - Phone:336-358-1528
Practice Address - Fax:336-358-1582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2001-01168207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891309KMedicaid
NC891309KMedicaid