Provider Demographics
NPI:1346480092
Name:NEURONEXUS, INC.
Entity Type:Organization
Organization Name:NEURONEXUS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:
Authorized Official - Last Name:WAKEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-508-4146
Mailing Address - Street 1:3535 PEACHTREE RD NE
Mailing Address - Street 2:SUITE# 520-637
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-3292
Mailing Address - Country:US
Mailing Address - Phone:678-508-4146
Mailing Address - Fax:678-829-0563
Practice Address - Street 1:3535 PEACHTREE RD NE
Practice Address - Street 2:SUITE# 520-637
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-3292
Practice Address - Country:US
Practice Address - Phone:678-508-4146
Practice Address - Fax:678-829-0563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Multi-Specialty
No246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEGGroup - Multi-Specialty