MEDICARE: ALICIA M PRICE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	F306046	NY
2	363L00000X	Nurse Practitioner	RN171017	GA
3	363LA2200X	Adult Health Nurse Practitioner	R212315	MD

General Provider Information

NPI Number	:	1093976664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA M PRICE NP

Provider Business Mailing Address
First Line	:	1486 HIGHWAY 74 N UNIT 107
Second Line	:
City	:	TYRONE
State	:	GA
Zip	:	30290-1661
Country	:	US
Telephone Number	:	646-918-0085
Fax Number	:

Provider Business Practice Location Address
First Line	:	7395 OLD RICO RD
Second Line	:
City	:	CHATTAHOOCHEE HILLS
State	:	GA
Zip	:	30268-2066
Country	:	US
Telephone Number	:	704-378-9673
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2008
Last Update Date	:	06/02/2026

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