Provider Demographics
NPI:1336569326
Name:ELITE NEURODIAGNOSTICS
Entity Type:Organization
Organization Name:ELITE NEURODIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDAENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:POREE
Authorized Official - Suffix:JR
Authorized Official - Credentials:CNIM
Authorized Official - Phone:404-805-4288
Mailing Address - Street 1:925B PEACHTREE ST NE
Mailing Address - Street 2:460
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3918
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:925B PEACHTREE ST NE
Practice Address - Street 2:460
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3918
Practice Address - Country:US
Practice Address - Phone:404-428-7041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty