Provider Demographics
NPI:1295359602
Name:PROFESSIONAL INTERPRETIVE NEURODIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:PROFESSIONAL INTERPRETIVE NEURODIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-616-3401
Mailing Address - Street 1:275 CORPORATE CENTER DR STE D
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7377
Mailing Address - Country:US
Mailing Address - Phone:678-782-7570
Mailing Address - Fax:
Practice Address - Street 1:275 CORPORATE CENTER DR STE D
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7377
Practice Address - Country:US
Practice Address - Phone:678-782-7570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty