Provider Demographics
NPI:1609909373
Name:ALAM-GONZALEZ, ALBERTO REINALDO (MD)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:REINALDO
Last Name:ALAM-GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALBERTO
Other - Middle Name:REINALDO
Other - Last Name:ALAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2721 S COBB DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-3240
Mailing Address - Country:US
Mailing Address - Phone:770-444-9494
Mailing Address - Fax:770-436-4656
Practice Address - Street 1:2721 S COBB DR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-3240
Practice Address - Country:US
Practice Address - Phone:770-444-9494
Practice Address - Fax:770-436-4656
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025407208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I379617Medicare UPIN
D28771Medicare UPIN
GA511G700201Medicare PIN