| Altergyn, Llc | |
|
1521 Johnson Ferry Rd Ste 135 Marietta GA 30062-6408 | |
| (678) 247-2115 | |
| (404) 393-8059 |
| Full Name | Altergyn, Llc |
|---|---|
| Speciality | General Practice |
| Location | 1521 Johnson Ferry Rd Ste 135, Marietta, Georgia |
| Authorized Official Name and Position | James Rochester Granger (M.D./OWNER) |
| Authorized Official Contact | 6782472115 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Altergyn, Llc 1521 Johnson Ferry Rd Ste 135 Marietta GA 30062-6408 Ph: (678) 247-2115 | Altergyn, Llc 1521 Johnson Ferry Rd Ste 135 Marietta GA 30062-6408 Ph: (678) 247-2115 |
| NPI Number | 1851861660 |
|---|---|
| Provider Enumeration Date | 12/05/2018 |
| Last Update Date | 12/01/2021 |
| Medicare PECOS PAC ID | 2466797501 |
|---|---|
| Medicare Enrollment ID | O20181218003877 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851861660 | NPI | - | NPPES |
| 1073714580 | Other | GA | GENERAL PRACTICE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | James R Granger |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1073714580 PECOS PAC ID: 9830173012 Enrollment ID: I20140715000612 |
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