Provider Demographics
NPI:1750652129
Name:ASCENSION HEALTH SERVICES
Entity Type:Organization
Organization Name:ASCENSION HEALTH SERVICES
Other - Org Name:ALPHA MEDICAL CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJENDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-821-1940
Mailing Address - Street 1:PO BOX 4888
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30023-4888
Mailing Address - Country:US
Mailing Address - Phone:770-821-1940
Mailing Address - Fax:770-821-1950
Practice Address - Street 1:3000 OLD ALABAMA RD
Practice Address - Street 2:SUITE 128 A
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30022-5860
Practice Address - Country:US
Practice Address - Phone:770-821-1940
Practice Address - Fax:770-821-1950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049523207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG24320Medicare UPIN