Provider Demographics
NPI:1063563013
Name:ALEXANDER EAR, NOSE AND THROAT
Entity type:Organization
Organization Name:ALEXANDER EAR, NOSE AND THROAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:JEFFERY
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:770-414-1130
Mailing Address - Street 1:2726 LAWRENCEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-2512
Mailing Address - Country:US
Mailing Address - Phone:770-414-1130
Mailing Address - Fax:770-414-1135
Practice Address - Street 1:2726 LAWRENCEVILLE HWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-2512
Practice Address - Country:US
Practice Address - Phone:770-414-1130
Practice Address - Fax:770-414-1135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029570174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000346442AMedicaid
GA04BDCLS01Medicare ID - Type UnspecifiedMEDICARE ID NUMBER
GAD44697Medicare UPIN