Provider Demographics
NPI:1629114095
Name:EAST ATLANTA NEUROLOGY AND HEADACHE CLINIC
Entity Type:Organization
Organization Name:EAST ATLANTA NEUROLOGY AND HEADACHE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCHUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-978-3578
Mailing Address - Street 1:1700 TREE LN RD STE 160
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6765
Mailing Address - Country:US
Mailing Address - Phone:770-978-3578
Mailing Address - Fax:770-978-6630
Practice Address - Street 1:1700 TREE LN
Practice Address - Street 2:SUITE 350
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6782
Practice Address - Country:US
Practice Address - Phone:770-978-3578
Practice Address - Fax:770-978-6630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032050174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACH2781OtherRAILROAD MEDICARE
GAGRP2586Medicare PIN