Provider Demographics
NPI:1639300700
Name:ALCOVY FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:ALCOVY FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-266-0305
Mailing Address - Street 1:705 BREEDLOVE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-2090
Mailing Address - Country:US
Mailing Address - Phone:770-266-0305
Mailing Address - Fax:
Practice Address - Street 1:705 BREEDLOVE DR
Practice Address - Street 2:STE 100
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2090
Practice Address - Country:US
Practice Address - Phone:770-266-0305
Practice Address - Fax:770-266-0310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055050207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty