Provider Demographics
NPI:1942376918
Name:COVENANT MULTISPECIALTY GROUP
Entity Type:Organization
Organization Name:COVENANT MULTISPECIALTY GROUP
Other - Org Name:COVENANT PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:GETTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-868-3251
Mailing Address - Street 1:4106 COLUMBIA RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-1450
Mailing Address - Country:US
Mailing Address - Phone:706-863-1440
Mailing Address - Fax:706-863-5418
Practice Address - Street 1:4106 COLUMBIA RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-1450
Practice Address - Country:US
Practice Address - Phone:706-863-1440
Practice Address - Fax:706-863-5418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA847566681CMedicaid