Provider Demographics
NPI:1760673537
Name:ALPHA MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:ALPHA MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELOY
Authorized Official - Middle Name:
Authorized Official - Last Name:FABRE GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-286-4824
Mailing Address - Street 1:619 E COLLEGE AVE STE C1
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-5326
Mailing Address - Country:US
Mailing Address - Phone:404-286-4824
Mailing Address - Fax:404-286-4825
Practice Address - Street 1:619 E COLLEGE AVE STE C1
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-5326
Practice Address - Country:US
Practice Address - Phone:404-286-4824
Practice Address - Fax:404-286-4825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty