Healthcare Provider Details

I. General information

NPI: 1912323700
Provider Name (Legal Business Name): DONALD W ALEXANDER, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2014
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CAMPBELL HILL ST NW SUITE 420
MARIETTA GA
30060-1134
US

IV. Provider business mailing address

833 CAMPBELL HILL ST NW SUITE 420
MARIETTA GA
30060-1134
US

V. Phone/Fax

Practice location:
  • Phone: 770-424-1968
  • Fax: 770-424-4782
Mailing address:
  • Phone: 770-424-1968
  • Fax: 770-424-4782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number21471
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number21471
License Number StateGA

VIII. Authorized Official

Name: DONALD W ALEXANDER
Title or Position: OWNER
Credential: MD
Phone: 770-424-7968