Provider Demographics
NPI:1205908217
Name:ALEXANDER, EMORY JEVODE (MD)
Entity type:Individual
Prefix:MR
First Name:EMORY
Middle Name:JEVODE
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 10TH AVE SUITE 320
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901
Mailing Address - Country:US
Mailing Address - Phone:706-653-6635
Mailing Address - Fax:706-653-8543
Practice Address - Street 1:1900 10TH AVE SUITE 320
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901
Practice Address - Country:US
Practice Address - Phone:706-653-6635
Practice Address - Fax:706-653-8543
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA39717207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00661922CMedicaid
ALK884OtherALA MEDICARE
GA00661922CMedicaid
ALK884OtherALA MEDICARE