Provider Demographics
NPI:1376755322
Name:ALPHA MEDICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:ALPHA MEDICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SATYANARAYANA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BASIREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-886-3747
Mailing Address - Street 1:107 COLONY PARK DR
Mailing Address - Street 2:SUITE 800
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2787
Mailing Address - Country:US
Mailing Address - Phone:770-886-3747
Mailing Address - Fax:770-886-3706
Practice Address - Street 1:107 COLONY PARK DR
Practice Address - Street 2:SUITE 800
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2787
Practice Address - Country:US
Practice Address - Phone:770-886-3747
Practice Address - Fax:770-886-3706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051209207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH09659Medicare UPIN
GA11BDWXNMedicare ID - Type UnspecifiedPROVIDER NUMBER
GAGRP6005Medicare ID - Type UnspecifiedGROUP NUMBER