Healthcare Provider Details

I. General information

NPI: 1003051012
Provider Name (Legal Business Name): ALPHA OB-GYN GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 11/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 POWERS FERRY RD BLDG 23
MARIETTA GA
30067-5491
US

IV. Provider business mailing address

1640 POWERS FERRY RD BLDG 23
MARIETTA GA
30067-5491
US

V. Phone/Fax

Practice location:
  • Phone: 404-584-8428
  • Fax: 770-690-9441
Mailing address:
  • Phone: 404-584-8428
  • Fax: 770-690-9441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number018697
License Number StateGA

VIII. Authorized Official

Name: DR. DANIEL ENOCH MCBRAYER SR.
Title or Position: DOCTOR
Credential: M.D.
Phone: 404-584-8428