Provider Demographics
NPI:1164774527
Name:SPORTS CONCUSSION INSTITUTE AT ATLANTA
Entity Type:Organization
Organization Name:SPORTS CONCUSSION INSTITUTE AT ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGLISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-856-4848
Mailing Address - Street 1:3200 DOWNWOOD CIR NW
Mailing Address - Street 2:SUITE 430
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-1659
Mailing Address - Country:US
Mailing Address - Phone:404-856-4848
Mailing Address - Fax:404-963-6572
Practice Address - Street 1:3200 DOWNWOOD CIR NW
Practice Address - Street 2:SUITE 430
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-1659
Practice Address - Country:US
Practice Address - Phone:404-856-4848
Practice Address - Fax:404-963-6572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048624207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty