Provider Demographics
NPI:1053658146
Name:SYNTACT, LLC
Entity Type:Organization
Organization Name:SYNTACT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLOUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:404-273-3968
Mailing Address - Street 1:1495 NATCHEZ WAY
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-2930
Mailing Address - Country:US
Mailing Address - Phone:404-273-3968
Mailing Address - Fax:404-601-9616
Practice Address - Street 1:1495 NATCHEZ WAY
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-2930
Practice Address - Country:US
Practice Address - Phone:404-273-3968
Practice Address - Fax:404-601-9616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA374352084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty