Provider Demographics
NPI:1568644995
Name:THE NEUROPSYCHOLOGY CENTER, LLC
Entity Type:Organization
Organization Name:THE NEUROPSYCHOLOGY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFONSO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-632-1088
Mailing Address - Street 1:6000 SHAKERAG HL
Mailing Address - Street 2:SUITE 216
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-6523
Mailing Address - Country:US
Mailing Address - Phone:770-632-1088
Mailing Address - Fax:770-632-2088
Practice Address - Street 1:6000 SHAKERAG HL
Practice Address - Street 2:SUITE 216
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-6523
Practice Address - Country:US
Practice Address - Phone:770-632-1088
Practice Address - Fax:770-632-2088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY3117103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54463YMedicare PIN