Provider Demographics
NPI:1801943378
Name:SOUTH ATLANTA NEUROLOGY & DIAGNOSTICS, PC
Entity type:Organization
Organization Name:SOUTH ATLANTA NEUROLOGY & DIAGNOSTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:S
Authorized Official - Last Name:HASAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-782-5000
Mailing Address - Street 1:7823 SPIVEY STATION BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2886
Mailing Address - Country:US
Mailing Address - Phone:678-782-5000
Mailing Address - Fax:678-289-9448
Practice Address - Street 1:7823 SPIVEY STATION BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2886
Practice Address - Country:US
Practice Address - Phone:678-782-5000
Practice Address - Fax:678-289-9448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0557572084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA526873369CMedicaid
GA526873369CMedicaid