MEDICARE: ALAN HERLINE MD

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	208C00000X	Colon & Rectal Surgery Physician	ME135852	FL
2	208C00000X	Colon & Rectal Surgery Physician	074669	GA
3	208600000X	Surgery Physician	ME135852	FL
4	208600000X	Surgery Physician	074669	GA

General Provider Information

NPI Number	:	1174622518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN HERLINE MD

Provider Business Mailing Address
First Line	:	780 CANTON RD NE STE 250
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-8928
Country	:	US
Telephone Number	:	943-202-8090
Fax Number	:	470-986-7227

Provider Business Practice Location Address
First Line	:	780 CANTON RD NE STE 250
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-8928
Country	:	US
Telephone Number	:	943-202-8090
Fax Number	:	470-986-7227

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	02/09/2026

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