Provider Demographics
NPI:1831190602
Name:KAHN, NEIL ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:ANDREW
Last Name:KAHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 IRVIN WAY
Mailing Address - Street 2:SUITE 211
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-5405
Mailing Address - Country:US
Mailing Address - Phone:404-501-0001
Mailing Address - Fax:404-501-0023
Practice Address - Street 1:2711 IRVIN WAY
Practice Address - Street 2:SUITE 211
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-5405
Practice Address - Country:US
Practice Address - Phone:404-501-0001
Practice Address - Fax:404-501-0023
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA304892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000375207BMedicaid
GA581896418OtherTAX IDENTIFICATION NUMBER
GA581896418OtherTAX IDENTIFICATION NUMBER
GAD45805Medicare UPIN
GA26LCBGBMedicare ID - Type UnspecifiedINDIVIDUAL ID NUMBER