Provider Demographics
NPI:1831175603
Name:ALPHA MEDICAL ASSOCIATES, INC
Entity type:Organization
Organization Name:ALPHA MEDICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:OLUFEMI
Authorized Official - Middle Name:O
Authorized Official - Last Name:ODUNUSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-666-2056
Mailing Address - Street 1:209 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37083-1701
Mailing Address - Country:US
Mailing Address - Phone:615-666-2056
Mailing Address - Fax:615-666-3022
Practice Address - Street 1:209 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:TN
Practice Address - Zip Code:37083-1701
Practice Address - Country:US
Practice Address - Phone:615-666-2056
Practice Address - Fax:615-666-3022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD024943173000000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3722161Medicare ID - Type Unspecified
TNF82487Medicare UPIN