Provider Demographics
NPI:1609853068
Name:VANALSTINE, ANDREW LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:LOUIS
Last Name:VANALSTINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 PENDLETON RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4837
Mailing Address - Country:US
Mailing Address - Phone:706-738-9824
Mailing Address - Fax:706-731-9918
Practice Address - Street 1:1417 PENDLETON RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4837
Practice Address - Country:US
Practice Address - Phone:706-738-9824
Practice Address - Fax:706-731-9918
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049951207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG49951Medicaid
GA00928892AMedicaid
GA00928892AMedicaid
GA080174886Medicare ID - Type UnspecifiedRAILROAD
GAH42335Medicare UPIN