Organization
ICH-EPG ALLIANCE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAN A. FULLER (PRESIDENT)
(770) 740-0895
Entity
Organization
Contact information
Practice address
217 S 3RD ST, DANVILLE, KY 40422-1823
(859) 239-5008
(859) 239-6793
Mailing address
318 MAXWELL RD, SUITE 500, ALPHARETTA, GA 30009-2063
(770) 740-0895
(770) 740-0896
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
03/30/2017
Last updated
05/09/2017
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