Provider Demographics
NPI:1770842932
Name:ATLANTA MEDICAL CENTER INTERVENTIONAL NEUROLOGY ASSOCIATES, LLC
Entity type:Organization
Organization Name:ATLANTA MEDICAL CENTER INTERVENTIONAL NEUROLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP PMI OPS & FINANCE, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:J.
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-893-6960
Mailing Address - Street 1:285 BOULEVARD NE
Mailing Address - Street 2:SUITE 415
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-4205
Mailing Address - Country:US
Mailing Address - Phone:404-265-4400
Mailing Address - Fax:404-265-4452
Practice Address - Street 1:285 BOULEVARD NE
Practice Address - Street 2:SUITE 415
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-4205
Practice Address - Country:US
Practice Address - Phone:404-265-4400
Practice Address - Fax:404-265-4452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty