Provider Demographics
NPI:1679935613
Name:GEORGE, ALECIA
Entity type:Individual
Prefix:
First Name:ALECIA
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5134 PEACHTREE RD
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-2724
Mailing Address - Country:US
Mailing Address - Phone:678-872-7100
Mailing Address - Fax:678-872-7104
Practice Address - Street 1:5134 PEACHTREE RD
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-2724
Practice Address - Country:US
Practice Address - Phone:678-872-7100
Practice Address - Fax:678-872-7104
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS17712080P0204X
390200000X
GA84997208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program