Provider Demographics
NPI:1205370459
Name:NEUROLOGICAL CENTER OF NORTH GEORGIA, LLC
Entity Type:Organization
Organization Name:NEUROLOGICAL CENTER OF NORTH GEORGIA, LLC
Other - Org Name:THE NEUROLOGICAL CENTER OF NORTH GEORGIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-961-0733
Mailing Address - Street 1:PO BOX 908621
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-0926
Mailing Address - Country:US
Mailing Address - Phone:678-961-0733
Mailing Address - Fax:
Practice Address - Street 1:1485 JESSE JEWELL PKWY NE STE 240A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3801
Practice Address - Country:US
Practice Address - Phone:678-961-0733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003204389AMedicaid