Basic Information
| Provider Information | |||||||||
| NPI: | 1477524965 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCALEXANDER | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 820 SAINT SEBASTIAN WAY | ||||||||
| Address2: | STE. 4C | ||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309012643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067745995 | ||||||||
| FaxNumber: | 7067745996 | ||||||||
| Practice Location | |||||||||
| Address1: | 820 SAINT SEBASTIAN WAY | ||||||||
| Address2: | STE. 4C | ||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309012643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067745995 | ||||||||
| FaxNumber: | 7067745996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2006 | ||||||||
| LastUpdateDate: | 06/17/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 29773 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 026329 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 566000156 | 01 | NC | GROUP TAX ID | OTHER | A2831 | 01 | NC | MEDCOST | OTHER | 0440057 | 01 | NC | UNITED HEALTHCARE | OTHER | 108993 | 01 | NC | WELLPATH | OTHER | 4298824 | 01 | NC | AETNA | OTHER | 55331 | 01 | NC | BCBS | OTHER | 110226262 | 01 | NC | RAILROAD MEDICARE | OTHER | 8955331 | 05 | NC | MEDICAID | 9281 | 01 | NC | PARTNERS MEDICARE CHOICE | OTHER | 896332 | 01 | NC | MAMSI | OTHER |