Basic Information
| Provider Information | |||||||||
| NPI: | 1043236482 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIANS ALLIANCE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 840 PINE ST | ||||||||
| Address2: | #750 | ||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4787455455 | ||||||||
| FaxNumber: | 4787452915 | ||||||||
| Practice Location | |||||||||
| Address1: | 840 PINE ST | ||||||||
| Address2: | #750 | ||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4787455455 | ||||||||
| FaxNumber: | 4787452915 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CAVALIERE | ||||||||
| AuthorizedOfficialFirstName: | LUDWIG | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 4787455455 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.