Provider Demographics
NPI:1649741604
Name:NEVILLE A ALEXANDER DPM PC
Entity Type:Organization
Organization Name:NEVILLE A ALEXANDER DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:NEVILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-520-7920
Mailing Address - Street 1:535 ASTON HALL WAY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-6634
Mailing Address - Country:US
Mailing Address - Phone:678-520-7920
Mailing Address - Fax:
Practice Address - Street 1:535 ASTON HALL WAY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-6634
Practice Address - Country:US
Practice Address - Phone:678-520-7920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPOD001042OtherMEDICAL LICENSE