Healthcare Provider Details

I. General information

NPI: 1750520482
Provider Name (Legal Business Name): ALICIA FAIR-JEMISON RT(R)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 02/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 PEACHTREE RD NW
ATLANTA GA
30309-1281
US

IV. Provider business mailing address

240 N HIGHLAND AVE NE #3310
ATLANTA GA
30307-5609
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-2929
  • Fax:
Mailing address:
  • Phone: 404-210-5101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number353391
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: