Provider Demographics
NPI:1487727343
Name:ALVARADO, MARIA IRMA (PHD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:IRMA
Last Name:ALVARADO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6345 JULIAN ROAD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-6413
Mailing Address - Country:US
Mailing Address - Phone:404-862-0838
Mailing Address - Fax:
Practice Address - Street 1:6345 JULIAN ROAD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30506-6413
Practice Address - Country:US
Practice Address - Phone:404-862-0838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT 001367174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA340094OtherWELLCARE OF GEORGIA ID