Provider Demographics
NPI:1336353093
Name:SOUTHEASTERN NEUROLOGY ASSOCIATES,LLC
Entity Type:Organization
Organization Name:SOUTHEASTERN NEUROLOGY ASSOCIATES,LLC
Other - Org Name:NEWTON HEALTH SYSTEM, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-787-8200
Mailing Address - Street 1:5211 HIGHWAY 278 NE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2671
Mailing Address - Country:US
Mailing Address - Phone:770-787-8210
Mailing Address - Fax:770-787-8228
Practice Address - Street 1:5211 HIGHWAY 278 NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2671
Practice Address - Country:US
Practice Address - Phone:770-787-8210
Practice Address - Fax:770-787-8228
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEWTON HEALTH SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-10
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043773174400000X
GA56605174400000X
GARN120924-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4521Medicare PIN