Provider Demographics
NPI:1619114667
Name:NEUROMATRIX RTM LLC
Entity Type:Organization
Organization Name:NEUROMATRIX RTM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:770-781-0800
Mailing Address - Street 1:5174 MCGINNIS FERRY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-1792
Mailing Address - Country:US
Mailing Address - Phone:770-781-0800
Mailing Address - Fax:770-781-0828
Practice Address - Street 1:6250 SHILOH RD
Practice Address - Street 2:SUITE 110
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-8388
Practice Address - Country:US
Practice Address - Phone:770-781-0800
Practice Address - Fax:770-781-0828
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE NEUROMATRIX GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-13
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty