Healthcare Provider Details

I. General information

NPI: 1831175603
Provider Name (Legal Business Name): ALPHA MEDICAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 COLLEGE ST
LAFAYETTE TN
37083-1701
US

IV. Provider business mailing address

209 COLLEGE ST
LAFAYETTE TN
37083-1701
US

V. Phone/Fax

Practice location:
  • Phone: 615-666-2056
  • Fax: 615-666-3022
Mailing address:
  • Phone: 615-666-2056
  • Fax: 615-666-3022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMD024943
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: OLUFEMI O ODUNUSI
Title or Position: PROVIDER
Credential: MD
Phone: 615-666-2056