Provider Demographics
NPI:1841029188
Name:ALCANTAR, EDGAR
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:
Last Name:ALCANTAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 MOHAWK CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-2456
Mailing Address - Country:US
Mailing Address - Phone:404-932-6895
Mailing Address - Fax:
Practice Address - Street 1:608 MOHAWK CIR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-2456
Practice Address - Country:US
Practice Address - Phone:404-932-6895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program