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1980 Riverside Pkwy Ste 101 Lawrenceville GA 30043-5943 | |
(678) 407-8230 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 1980 Riverside Pkwy Ste 101, Lawrenceville, Georgia |
Authorized Official Name and Position | Raymond Alexander (PRESIDENT) |
Authorized Official Contact | 6784078230 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1980 Riverside Pkwy Ste 101 Lawrenceville GA 30043-5943 Ph: (678) 407-8230 | 1980 Riverside Pkwy Ste 101 Lawrenceville GA 30043-5943 Ph: (678) 407-8230 |
NPI Number | 1487887055 |
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Provider Enumeration Date | 08/31/2009 |
Last Update Date | 08/31/2009 |
Medicare PECOS PAC ID | 4183761182 |
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Medicare Enrollment ID | O20091023000395 |
Identifier | Type | State | Issuer |
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1487887055 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QC1500X | Clinic/center - Community Health | 2925 (Georgia) | Primary |
Provider Name | Raymond T Alexander |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1023030392 PECOS PAC ID: 3375680374 Enrollment ID: I20091023000376 |
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