Provider Demographics
NPI:1356385058
Name:ALBANY NEUROSURGERY CENTER, LLC
Entity type:Organization
Organization Name:ALBANY NEUROSURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-432-8450
Mailing Address - Street 1:1909 ABERDEEN RD
Mailing Address - Street 2:STE 106
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1393
Mailing Address - Country:US
Mailing Address - Phone:229-432-8450
Mailing Address - Fax:
Practice Address - Street 1:1909 ABERDEEN RD
Practice Address - Street 2:STE 106
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1393
Practice Address - Country:US
Practice Address - Phone:229-432-8450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty