Provider Demographics
NPI:1164783270
Name:CENTER FOR NEUROCOGNITIVE ASSESSMENT AND REHABILITATION, PC
Entity Type:Organization
Organization Name:CENTER FOR NEUROCOGNITIVE ASSESSMENT AND REHABILITATION, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:CLAUDINE
Authorized Official - Last Name:STYPEREK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-291-4447
Mailing Address - Street 1:305 CLARK DR SE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-6035
Mailing Address - Country:US
Mailing Address - Phone:404-291-4447
Mailing Address - Fax:
Practice Address - Street 1:512 RIVERSIDE PKWY NE STE 300
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-2939
Practice Address - Country:US
Practice Address - Phone:404-291-4447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003542261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center