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General NPI Number Information
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NPI Number | 1063563013
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Entity Type | Organization
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Legal Business Name | ALEXANDER EAR, NOSE AND THROAT
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 08/31/2015
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Provider Practice Location Address
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Address Line | 2726 LAWRENCEVILLE HWY
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City | DECATUR
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State | GA
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Zip | 30033-2512
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Country | US
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Telephone | 770-414-1130
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Fax | 770-414-1135
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Provider Business Mailing Address
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Address Line | 2726 LAWRENCEVILLE HWY
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City | DECATUR
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State | GA
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Zip | 30033-2512
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Country | US
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Telephone | 770-414-1130
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Fax | 770-414-1135
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JOEL JEFFERY ALEXANDER
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Credential | D.O.
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Telephone | 770-414-1130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 029570
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License Number State | GA
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