Provider Demographics
NPI:1558414276
Name:LEVY, ALAN MERRILL (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:MERRILL
Last Name:LEVY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 MEDICAL BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5083
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:191 MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5083
Practice Address - Country:US
Practice Address - Phone:678-604-5015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA35930208600000X
GA0359302086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52292901006OtherBLUE CROSS BLUE SHIELD
GA1633261-009OtherCIGNA
GA288074OtherWELLCARE CHOICE PLAN
GA4239358OtherAETNA
GA770001403OtherRAILROAD MEDICARE
GA000509748CMedicaid
GA581800973OtherUNITED HEALTHCARE
GA770001403OtherRAILROAD MEDICARE
GA52292901006OtherBLUE CROSS BLUE SHIELD