Basic Information
| Provider Information | |||||||||
| NPI: | 1164464194 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALVEAR | ||||||||
| FirstName: | JORGE | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5730 GLENRIDGE DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | SANDY SPGS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303285579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048163000 | ||||||||
| FaxNumber: | 4049460404 | ||||||||
| Practice Location | |||||||||
| Address1: | 5730 GLENRIDGE DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | SANDY SPGS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048163000 | ||||||||
| FaxNumber: | 4049460404 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 07/05/2018 | ||||||||
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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 | 207L00000X | 052109 | GA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0000X | 052109 | GA | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 207LP2900X | 052109 | GA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000970274B | 05 | GA | MEDICAID | 00970274A | 05 | GA | MEDICAID |