Healthcare Provider Details

I. General information

NPI: 1063860740
Provider Name (Legal Business Name): ALPHA RECOVERY GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 06/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 MCCLURE BRIDGE RD BUILDING C, SUIT A&B
DULUTH GA
30096-6675
US

IV. Provider business mailing address

3400 MCCLURE BRIDGE RD BUILDING C, SUIT A&B
DULUTH GA
30096-6675
US

V. Phone/Fax

Practice location:
  • Phone: 770-896-6730
  • Fax: 770-896-6730
Mailing address:
  • Phone: 770-896-6730
  • Fax: 770-896-6730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StateGA

VIII. Authorized Official

Name: DR. ADAM I ALIMI
Title or Position: CEO
Credential: BSC, MSC
Phone: 770-896-6730