Provider Demographics
NPI:1093098469
Name:NEUROCARE INSTITUTE OF GEORGIA
Entity Type:Organization
Organization Name:NEUROCARE INSTITUTE OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-289-8662
Mailing Address - Street 1:950 EAGLES LANDING PKWY # 261
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7343
Mailing Address - Country:US
Mailing Address - Phone:678-289-8662
Mailing Address - Fax:678-289-8691
Practice Address - Street 1:135 EAGLES WALK
Practice Address - Street 2:SUITE 150
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7206
Practice Address - Country:US
Practice Address - Phone:678-289-8662
Practice Address - Fax:678-289-8691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty