Provider Demographics
NPI:1649213471
Name:ALEXANDER, KEMILY TRINETTE (OD)
Entity type:Individual
Prefix:DR
First Name:KEMILY
Middle Name:TRINETTE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1238 BRENDA CT NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-3889
Mailing Address - Country:US
Mailing Address - Phone:601-455-1155
Mailing Address - Fax:
Practice Address - Street 1:4373 JIMMY LEE PKWY STE 101
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141
Practice Address - Country:US
Practice Address - Phone:770-943-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS725152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03458053Medicaid
MS03458053Medicaid