Healthcare Provider Details

I. General information

NPI: 1821099987
Provider Name (Legal Business Name): CLIVE ALBERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NORTHSIDE FORSYTH DR SUITE 330
CUMMING GA
30041-6012
US

IV. Provider business mailing address

PO BOX 922149
NORCROSS GA
30010-2149
US

V. Phone/Fax

Practice location:
  • Phone: 770-889-9901
  • Fax: 770-889-9088
Mailing address:
  • Phone: 770-889-9901
  • Fax: 770-889-9088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number035800
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: