Provider Demographics
NPI:1932135183
Name:NORTH GEORGIA NEUROLOGICAL INSTITUTE
Entity Type:Organization
Organization Name:NORTH GEORGIA NEUROLOGICAL INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILGENAST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-275-6121
Mailing Address - Street 1:1505 PROFESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2500
Mailing Address - Country:US
Mailing Address - Phone:706-275-6121
Mailing Address - Fax:706-275-0521
Practice Address - Street 1:1505 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2500
Practice Address - Country:US
Practice Address - Phone:706-275-6121
Practice Address - Fax:706-275-0521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP1670Medicare ID - Type Unspecified