Provider Demographics
NPI:1760900708
Name:NEURO DIAGNOSTIC GROUP LLC
Entity Type:Organization
Organization Name:NEURO DIAGNOSTIC GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:OFFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DANAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-695-5500
Mailing Address - Street 1:200 GALLERIA PKWY SE STE 100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5944
Mailing Address - Country:US
Mailing Address - Phone:855-411-2225
Mailing Address - Fax:800-886-1731
Practice Address - Street 1:200 GALLERIA PKWY SE STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5944
Practice Address - Country:US
Practice Address - Phone:855-411-2225
Practice Address - Fax:800-886-1731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA598702081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1679765523OtherNEUROLOGY