Provider Demographics
NPI:1497224380
Name:ALPHARETTA MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:ALPHARETTA MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-542-4488
Mailing Address - Street 1:11807 NORTHFALL LN STE 901
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-7972
Mailing Address - Country:US
Mailing Address - Phone:678-240-0049
Mailing Address - Fax:
Practice Address - Street 1:11807 NORTHFALL LN STE 901
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-7972
Practice Address - Country:US
Practice Address - Phone:678-240-0049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty