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General NPI Number Information
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NPI Number | 1083622849
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Entity Type | Organization
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Legal Business Name | ALPHA INTERNAL MEDICINE, LLC
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 04/01/2014
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Provider Practice Location Address
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Address Line | 745 GLYNN ST S
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-2049
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Country | US
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Telephone | 770-719-5490
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 142459
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-6515
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Country | US
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Telephone | 770-719-5490
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Fax | 770-719-3113
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BETSY S HORTON
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Credential | M.D.
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Telephone | 770-719-5490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 055270
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 053123
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 047760
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 720353
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 040693
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License Number State | GA
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