Healthcare Provider Details

I. General information

NPI: 1457998742
Provider Name (Legal Business Name): MY MEDICAL ALLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 12/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 BUFORD HWY NE
ATLANTA GA
30324-3207
US

IV. Provider business mailing address

PO BOX 550747
ATLANTA GA
30355-3247
US

V. Phone/Fax

Practice location:
  • Phone: 404-477-1797
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALESIA REYNOLDS
Title or Position: OWNER
Credential:
Phone: 404-477-1797