Provider Demographics
NPI:1952415291
Name:GEORGIA NEUROPSYCHOLOGY, LLC
Entity Type:Organization
Organization Name:GEORGIA NEUROPSYCHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEURO PSYCOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHINDELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-605-0485
Mailing Address - Street 1:3200 DOWNWOOD CIR NW
Mailing Address - Street 2:STE 230
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-1610
Mailing Address - Country:US
Mailing Address - Phone:404-605-0485
Mailing Address - Fax:404-605-9695
Practice Address - Street 1:3200 DOWNWOOD CIR NW
Practice Address - Street 2:STE 230
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-1610
Practice Address - Country:US
Practice Address - Phone:404-605-0485
Practice Address - Fax:404-605-9695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001321103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAR80940Medicare UPIN