Provider Demographics
NPI:1720614746
Name:NEUROPSYCHOLOGY ASSOCIATES OF GEORGIA LLC
Entity Type:Organization
Organization Name:NEUROPSYCHOLOGY ASSOCIATES OF GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-641-6204
Mailing Address - Street 1:280 INTERSTATE NORTH CIR SE STE 450
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2451
Mailing Address - Country:US
Mailing Address - Phone:678-641-6204
Mailing Address - Fax:
Practice Address - Street 1:280 INTERSTATE NORTH CIR SE STE 450
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2451
Practice Address - Country:US
Practice Address - Phone:678-641-6204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-21
Last Update Date:2020-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty