Provider Demographics
NPI:1649417890
Name:NEUROLOGY OF CENTRAL GEORGIA, LLC
Entity Type:Organization
Organization Name:NEUROLOGY OF CENTRAL GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDHIR
Authorized Official - Middle Name:S
Authorized Official - Last Name:ATHNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-471-6217
Mailing Address - Street 1:175 WATER TOWER CT
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4874
Mailing Address - Country:US
Mailing Address - Phone:478-471-6217
Mailing Address - Fax:478-471-8663
Practice Address - Street 1:175 WATER TOWER CT
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-4874
Practice Address - Country:US
Practice Address - Phone:478-471-6217
Practice Address - Fax:478-471-8663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty