Provider Demographics
NPI:1679563423
Name:PERRY, ALAN D (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:D
Last Name:PERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:232 19TH ST NW
Mailing Address - Street 2:SUITE 7220
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30363-1130
Mailing Address - Country:US
Mailing Address - Phone:404-367-3000
Mailing Address - Fax:404-609-7628
Practice Address - Street 1:232 19TH ST NW
Practice Address - Street 2:SUITE 7220
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30363-1130
Practice Address - Country:US
Practice Address - Phone:404-367-3000
Practice Address - Fax:404-609-7628
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA47990207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1104020002OtherPEACHSTATE
GAP00124116OtherRAILROAD MEDICARE
GA313965OtherWELLCARE
GA8708OtherKAISER
GA10033145OtherAMERIGROUP
GA52702796001OtherBC/BS GEORGIA
GA000910896AMedicaid
GA0101672OtherUNITED HEALTHCARE
GAH41964Medicare UPIN
GA000910896AMedicaid