Provider Demographics
NPI:1346293164
Name:REA, ALFONSO E (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFONSO
Middle Name:E
Last Name:REA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:55 WHITCHER ST NE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1155
Mailing Address - Country:US
Mailing Address - Phone:770-424-6893
Mailing Address - Fax:770-528-9938
Practice Address - Street 1:1700 HOSPITAL SOUTH DR
Practice Address - Street 2:SUITE 409
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-6810
Practice Address - Country:US
Practice Address - Phone:770-424-6893
Practice Address - Fax:770-528-9938
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2014-02-13
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Provider Licenses
StateLicense IDTaxonomies
GA51719207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA473403602BMedicaid
GA000958548JMedicaid
GA000958548MMedicaid
GA000958548KMedicaid
GA473403602BMedicaid
GA000958548JMedicaid
GAH07919Medicare UPIN