Provider Demographics
NPI:1851454391
Name:ALEXANDER, ELMORE DEAN (DO)
Entity Type:Individual
Prefix:DR
First Name:ELMORE
Middle Name:DEAN
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:ELMORE
Other - Middle Name:DEAN
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:374 OSPREY PT
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-6163
Mailing Address - Country:US
Mailing Address - Phone:678-694-8258
Mailing Address - Fax:678-805-0077
Practice Address - Street 1:374 OSPREY POINT
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-6163
Practice Address - Country:US
Practice Address - Phone:678-694-8258
Practice Address - Fax:678-805-0077
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2014-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033908207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000467123CMedicaid
GA08LCBZMMedicare PIN
GAE90206Medicare UPIN