Basic Information
| Provider Information | |||||||||
| NPI: | 1558414276 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEVY | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | MERRILL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1035 SOUTHCREST DR | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | STOCKBRIDGE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302816118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709969945 | ||||||||
| FaxNumber: | 7709967355 | ||||||||
| Practice Location | |||||||||
| Address1: | 1035 SOUTHCREST DR | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | STOCKBRIDGE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302816118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709969945 | ||||||||
| FaxNumber: | 7709967355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 03/18/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | 035930 | GA | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 770001403 | 01 | GA | RAILROAD MEDICARE | OTHER | 288074 | 01 | GA | WELLCARE CHOICE PLAN | OTHER | 4239358 | 01 | GA | AETNA | OTHER | 000509748C | 05 | GA | MEDICAID | 1633261-009 | 01 | GA | CIGNA | OTHER | 52292901006 | 01 | GA | BLUE CROSS BLUE SHIELD | OTHER | 581800973 | 01 | GA | UNITED HEALTHCARE | OTHER |