Provider Demographics
NPI:1679513865
Name:MEISEL, JEREMY NEIL (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:NEIL
Last Name:MEISEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1579 MONROE DR NE STE F
Mailing Address - Street 2:STE F 602
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-5022
Mailing Address - Country:US
Mailing Address - Phone:215-243-2938
Mailing Address - Fax:215-243-2938
Practice Address - Street 1:1579 MONROE DR NE STE F
Practice Address - Street 2:STE F 602
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-5022
Practice Address - Country:US
Practice Address - Phone:215-243-2938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2200352084N0400X
PAMD 4255022084N0400X
ND101772084N0400X
GA0527862084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI20773Medicare UPIN