Provider Demographics
NPI:1942360912
Name:NORTHWEST NEUROLOGY, P.C.
Entity Type:Organization
Organization Name:NORTHWEST NEUROLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-819-1717
Mailing Address - Street 1:3875 AUSTELL RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1103
Mailing Address - Country:US
Mailing Address - Phone:770-819-1717
Mailing Address - Fax:770-819-1140
Practice Address - Street 1:4460 AUSTELL RD
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1844
Practice Address - Country:US
Practice Address - Phone:770-941-4716
Practice Address - Fax:770-941-3047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0124992084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CB2386OtherRAILROAD MEDICARE
GAGRP35Medicare PIN