Provider Demographics
NPI:1790118131
Name:JEREMY MEISEL MD LLC
Entity Type:Organization
Organization Name:JEREMY MEISEL MD LLC
Other - Org Name:ADVANCED NEUROLOGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEISEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-501-5420
Mailing Address - Street 1:1579 MONROE DR NE STE F
Mailing Address - Street 2:SUITE F602
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-5022
Mailing Address - Country:US
Mailing Address - Phone:678-501-5420
Mailing Address - Fax:678-501-5429
Practice Address - Street 1:4904 TIMBER RIDGE DR
Practice Address - Street 2:SUITE 305
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1828
Practice Address - Country:US
Practice Address - Phone:678-501-5420
Practice Address - Fax:678-501-5429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0527862084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA612935883DMedicaid
GA612935883DMedicaid