Provider Demographics
NPI:1700036050
Name:GREATER ATLANTA NEUROSURGERY PC
Entity Type:Organization
Organization Name:GREATER ATLANTA NEUROSURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:STECHISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:404-522-3330
Mailing Address - Street 1:PO BOX 71406
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31708-1406
Mailing Address - Country:US
Mailing Address - Phone:404-522-3330
Mailing Address - Fax:404-522-3332
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:SUITE 1577
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2247
Practice Address - Country:US
Practice Address - Phone:404-522-3330
Practice Address - Fax:404-522-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4673Medicare PIN