MEDICARE: MR. RAYMOND NMN ALEXANDER II PHD.

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	219	GA

General Provider Information

NPI Number	:	1902929284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAYMOND NMN ALEXANDER II PHD.

Provider Business Mailing Address
First Line	:	821 MCGILL PARK AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-1274
Country	:	US
Telephone Number	:	404-664-8838
Fax Number	:

Provider Business Practice Location Address
First Line	:	821 MCGILL PARK AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-1274
Country	:	US
Telephone Number	:	404-664-8838
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	07/08/2007

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