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General NPI Number Information
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NPI Number | 1720154594
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Entity Type | Individual
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Provider Name | DAVID LEE ALEXANDER III PA
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Gender | Male
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Dates
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Enumeration Date | 11/25/2006
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 1412 MILSTEAD AVE NE
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City | CONYERS
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State | GA
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Zip | 30012-3877
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Country | US
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Telephone | 404-605-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 1484 TETHER LN
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City | MCDONOUGH
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State | GA
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Zip | 30253-9210
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Country | US
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Telephone |
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Fax | 404-351-5983
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 004894
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 4894
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License Number State | GA
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