Provider Demographics
NPI:1518034222
Name:ADULT NEUROLOGY OF NORTH ATLANTA, P.C.
Entity Type:Organization
Organization Name:ADULT NEUROLOGY OF NORTH ATLANTA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-663-8765
Mailing Address - Street 1:11660 ALPHARETTA HWY
Mailing Address - Street 2:SUITE 420
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4943
Mailing Address - Country:US
Mailing Address - Phone:770-663-8765
Mailing Address - Fax:770-664-6134
Practice Address - Street 1:11660 ALPHARETTA HWY
Practice Address - Street 2:SUITE 420
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4943
Practice Address - Country:US
Practice Address - Phone:770-663-8765
Practice Address - Fax:770-664-6134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032534174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6681Medicare PIN