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General NPI Number Information
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NPI Number | 1528260445
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Entity Type | Individual
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Provider Name | MARY S.E. ALSTON MD
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Gender | Female
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | DONOVAN HARRISON ROAD MEDICAL DEPARTMENT
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City | WRIGHTSVILLE
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State | GA
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Zip | 31096
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Country | US
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Telephone | 478-864-4973
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Fax | 478-864-4274
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Provider Business Mailing Address
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Address Line | 2 MADICO CHASE
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City | SAVANNAH
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State | GA
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Zip | 31419-8807
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Country | US
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Telephone | 912-920-4389
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 033261
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License Number State | GA
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