Provider Demographics
NPI:1851861660
Name:ALTERGYN, LLC
Entity type:Organization
Organization Name:ALTERGYN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:M.D./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROCHESTER
Authorized Official - Last Name:GRANGER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:678-247-2115
Mailing Address - Street 1:1521 JOHNSON FERRY RD STE 135
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6408
Mailing Address - Country:US
Mailing Address - Phone:678-247-2115
Mailing Address - Fax:404-393-8059
Practice Address - Street 1:1521 JOHNSON FERRY RD STE 135
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6408
Practice Address - Country:US
Practice Address - Phone:678-247-2115
Practice Address - Fax:404-393-8059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-05
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1073714580OtherGENERAL PRACTICE