Provider Demographics
NPI:1578736286
Name:LOST MOUNTAIN INTERNAL MEDICINE, LLC
Entity Type:Organization
Organization Name:LOST MOUNTAIN INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALACIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TARPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-874-0692
Mailing Address - Street 1:5041 DALLAS HWY
Mailing Address - Street 2:BLDG 1, SUITE H
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-6458
Mailing Address - Country:US
Mailing Address - Phone:770-874-0692
Mailing Address - Fax:770-874-0696
Practice Address - Street 1:5041 DALLAS HWY
Practice Address - Street 2:BLDG 1, SUITE H
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-6458
Practice Address - Country:US
Practice Address - Phone:770-874-0692
Practice Address - Fax:770-874-0696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7330Medicare PIN