Provider Demographics
NPI:1932485125
Name:CHILDREN'S NEUROLOGY CTR MACON, LLC
Entity Type:Organization
Organization Name:CHILDREN'S NEUROLOGY CTR MACON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:TRASMONTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-750-8880
Mailing Address - Street 1:840 PINE ST
Mailing Address - Street 2:SUITE 970
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2100
Mailing Address - Country:US
Mailing Address - Phone:478-750-8880
Mailing Address - Fax:478-750-8860
Practice Address - Street 1:840 PINE ST
Practice Address - Street 2:STE 970
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2100
Practice Address - Country:US
Practice Address - Phone:478-750-8880
Practice Address - Fax:478-750-8860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA441272084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA706246275AMedicaid
GA000755917EMedicaid
GA706246275BMedicaid