Provider Demographics
NPI:1457649519
Name:ALPHARETTA FAMILY PRACTICE
Entity Type:Organization
Organization Name:ALPHARETTA FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCGAULEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-475-3200
Mailing Address - Street 1:3330 PRESTON RIDGE RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4508
Mailing Address - Country:US
Mailing Address - Phone:770-475-3200
Mailing Address - Fax:770-475-2228
Practice Address - Street 1:3330 PRESTON RIDGE RD
Practice Address - Street 2:SUITE 340
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4508
Practice Address - Country:US
Practice Address - Phone:770-475-3200
Practice Address - Fax:770-475-2228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08BBWHKOtherPTAN
GAF66820Medicare UPIN