Healthcare Provider Details

I. General information

NPI: 1780617365
Provider Name (Legal Business Name): ALONZO T SEXTON II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 EAGLES LANDING PKWY STE 300
STOCKBRIDGE GA
30281-5173
US

IV. Provider business mailing address

900 CIRCLE 75 PKWY SE STE 1700
ATLANTA GA
30339-3087
US

V. Phone/Fax

Practice location:
  • Phone: 770-506-4350
  • Fax: 770-506-9860
Mailing address:
  • Phone: 770-953-6929
  • Fax: 770-953-6972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number53617
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: