Healthcare Provider Details

I. General information

NPI: 1245985076
Provider Name (Legal Business Name): ALPHA DIAGNOSTIC SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 02/21/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4568 CLOISTER CIR
HAMPTON GA
30228-3640
US

IV. Provider business mailing address

4568 CLOISTER CIR
HAMPTON GA
30228-3640
US

V. Phone/Fax

Practice location:
  • Phone: 470-332-0033
  • Fax:
Mailing address:
  • Phone: 470-332-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: FLORENCE O OLAMIGOKE
Title or Position: RN
Credential: RN
Phone: 470-332-0033