Healthcare Provider Details

I. General information

NPI: 1487734414
Provider Name (Legal Business Name): RONALD J ALVAREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 12/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 OLD MILTON PKWY STE 300
ALPHARETTA GA
30009-2140
US

IV. Provider business mailing address

80 LACY ST NW
MARIETTA GA
30060-1107
US

V. Phone/Fax

Practice location:
  • Phone: 770-740-1860
  • Fax: 678-347-2104
Mailing address:
  • Phone: 770-427-0368
  • Fax: 678-581-5969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number051404
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: