Provider Demographics
NPI:1356759716
Name:ALLIANCE MEDICAL NETWORK
Entity type:Organization
Organization Name:ALLIANCE MEDICAL NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YUL
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:GASH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:404-226-7769
Mailing Address - Street 1:1750 POWDER SPRINGS RD SW
Mailing Address - Street 2:SUITE 190-162
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4850
Mailing Address - Country:US
Mailing Address - Phone:404-226-7769
Mailing Address - Fax:
Practice Address - Street 1:1750 POWDER SPRINGS RD SW
Practice Address - Street 2:SUITE 190-162
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4850
Practice Address - Country:US
Practice Address - Phone:404-226-7769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty