Provider Demographics
NPI:1558393496
Name:ERINJERI, ALPHONSA J (MD)
Entity Type:Individual
Prefix:DR
First Name:ALPHONSA
Middle Name:J
Last Name:ERINJERI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 WATSON BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3484
Mailing Address - Country:US
Mailing Address - Phone:478-922-9205
Mailing Address - Fax:
Practice Address - Street 1:1524 WATSON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3484
Practice Address - Country:US
Practice Address - Phone:478-922-9205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039565208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00655487BMedicaid