MEDICARE: ALLIANCE HEALTH CARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	66399	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	475566527	OTHER	GA	RADIOLOGY

General Provider Information

NPI Number	:	1346740230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE HEALTH CARE INC

Provider Business Mailing Address
First Line	:	3545 CRUSE RD STE 103
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-3169
Country	:	US
Telephone Number	:	770-456-5666
Fax Number	:	770-456-5726

Provider Business Practice Location Address
First Line	:	3545 CRUSE RD STE 103
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-3169
Country	:	US
Telephone Number	:	770-456-5666
Fax Number	:	770-456-5726

Authorized Official
Title or Position	:	MANAGER
Name	:	SHARON SELENA DUNCAN
Credential	:
Telephone Number	:	205-588-4779

Provider Enumeration Date	:	02/16/2018
Last Update Date	:	08/17/2018

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