Provider Demographics
NPI:1891701496
Name:ALFORD, CORRIE VANEXEL (MD)
Entity type:Individual
Prefix:DR
First Name:CORRIE
Middle Name:VANEXEL
Last Name:ALFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CORRIE
Other - Middle Name:ELIZABETH
Other - Last Name:ALFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:148 BILL CARRUTH PKWY.
Mailing Address - Street 2:SUITE 280
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141
Mailing Address - Country:US
Mailing Address - Phone:678-363-3343
Mailing Address - Fax:678-363-3380
Practice Address - Street 1:148 BILL CARRUTH PKWY.
Practice Address - Street 2:SUITE 280
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141
Practice Address - Country:US
Practice Address - Phone:678-363-3343
Practice Address - Fax:678-363-3380
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA57567207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology