Provider Demographics
NPI:1538495999
Name:NEUROLOGICAL INSTITUTE OF ATLANTA
Entity Type:Organization
Organization Name:NEUROLOGICAL INSTITUTE OF ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:SHENKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-265-1357
Mailing Address - Street 1:1111 GLYNCO PKWY
Mailing Address - Street 2:STE 400
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-7921
Mailing Address - Country:US
Mailing Address - Phone:912-265-1357
Mailing Address - Fax:912-265-0495
Practice Address - Street 1:1111 GLYNCO PKWY
Practice Address - Street 2:STE 400
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-7921
Practice Address - Country:US
Practice Address - Phone:912-265-1357
Practice Address - Fax:912-265-0495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036002084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Multi-Specialty