Healthcare Provider Details

I. General information

NPI: 1760831069
Provider Name (Legal Business Name): NEENA ALEX M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 AUSTELL RD
AUSTELL GA
30106-1121
US

IV. Provider business mailing address

160 E ERIE AVE
PHILADELPHIA PA
19134-1011
US

V. Phone/Fax

Practice location:
  • Phone: 770-732-4022
  • Fax:
Mailing address:
  • Phone: 215-427-3768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT210605
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number83080
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number83080
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: