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General NPI Number Information
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NPI Number | 1639300700
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Entity Type | Organization
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Legal Business Name | ALCOVY FAMILY MEDICINE, LLC
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Dates
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Enumeration Date | 08/06/2009
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Last Update Date | 08/06/2009
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Provider Practice Location Address
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Address Line | 705 BREEDLOVE DR STE 100
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City | MONROE
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State | GA
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Zip | 30655-2090
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Country | US
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Telephone | 770-266-0305
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Fax | 770-266-0310
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Provider Business Mailing Address
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Address Line | 705 BREEDLOVE DR STE 100
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City | MONROE
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State | GA
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Zip | 30655-2090
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Country | US
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Telephone | 770-266-0305
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MELVIN GLOVER
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Credential | M.D.
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Telephone | 770-266-0305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 055050
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License Number State | GA
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