Provider Demographics
NPI:1528260445
Name:ALSTON, MARY SE (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:SE
Last Name:ALSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2 MADICO CHASE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-8807
Mailing Address - Country:US
Mailing Address - Phone:912-920-4389
Mailing Address - Fax:
Practice Address - Street 1:DONOVAN HARRISON ROAD
Practice Address - Street 2:MEDICAL DEPARTMENT
Practice Address - City:WRIGHTSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31096
Practice Address - Country:US
Practice Address - Phone:478-864-4973
Practice Address - Fax:478-864-4274
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA033261207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine