Healthcare Provider Details

I. General information

NPI: 1255862538
Provider Name (Legal Business Name): AMY MYRE FALLEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3508 OLD MILTON PKWY
ALPHARETTA GA
30005-4458
US

IV. Provider business mailing address

3508 OLD MILTON PKWY
ALPHARETTA GA
30005-4458
US

V. Phone/Fax

Practice location:
  • Phone: 678-404-5521
  • Fax: 470-275-0879
Mailing address:
  • Phone: 678-404-5521
  • Fax: 470-275-0879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number89253
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: