Provider Demographics
NPI:1821099987
Name:ALBERT, CLIVE (MD)
Entity Type:Individual
Prefix:DR
First Name:CLIVE
Middle Name:
Last Name:ALBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 922149
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30010-2149
Mailing Address - Country:US
Mailing Address - Phone:770-889-9901
Mailing Address - Fax:770-889-9088
Practice Address - Street 1:1100 NORTHSIDE FORSYTH DR
Practice Address - Street 2:SUITE 330
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6012
Practice Address - Country:US
Practice Address - Phone:770-889-9901
Practice Address - Fax:770-889-9088
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA035800207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000511948DMedicaid
GAF36336Medicare UPIN
GA000511948DMedicaid