Provider Demographics
NPI:1104127034
Name:ALPHA URGENT CARE 01 LLC
Entity type:Organization
Organization Name:ALPHA URGENT CARE 01 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:PAGE
Authorized Official - Last Name:WINEMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:770-296-5876
Mailing Address - Street 1:12315 CRABAPPLE RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-6329
Mailing Address - Country:US
Mailing Address - Phone:678-762-9292
Mailing Address - Fax:678-762-9298
Practice Address - Street 1:12315 CRABAPPLE RD
Practice Address - Street 2:SUITE 108
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-6329
Practice Address - Country:US
Practice Address - Phone:678-762-9292
Practice Address - Fax:678-762-9298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10051208261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care