Provider Demographics
NPI:1568513752
Name:DOMAN, ALEXANDER NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:NICHOLAS
Last Name:DOMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 FOREST PARKWAY #111
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297
Mailing Address - Country:US
Mailing Address - Phone:404-362-9935
Mailing Address - Fax:404-362-9938
Practice Address - Street 1:425 FOREST PKWY STE 111
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-2135
Practice Address - Country:US
Practice Address - Phone:404-362-9935
Practice Address - Fax:404-362-9938
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033313207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00444881AMedicaid
GA00444881AMedicaid
GA20BDBLVMedicare PIN