Healthcare Provider Details

I. General information

NPI: 1578530325
Provider Name (Legal Business Name): ALPHACARE MEDICAL CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1865 LOCKEWAY DR SUITE 603
ALPHARETTA GA
30004-5928
US

IV. Provider business mailing address

1865 LOCKEWAY DR STE 603
ALPHARETTA GA
30004-5938
US

V. Phone/Fax

Practice location:
  • Phone: 770-752-8440
  • Fax: 770-752-8990
Mailing address:
  • Phone: 770-752-8440
  • Fax: 770-752-8990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIAM LATIF
Title or Position: M.D.
Credential:
Phone: 770-752-8440