MEDICARE: ALBANY NEUROSURGERY CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician

General Provider Information

NPI Number	:	1356385058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALBANY NEUROSURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	1909 ABERDEEN RD
Second Line	:	STE 106
City	:	ALBANY
State	:	GA
Zip	:	31701-1393
Country	:	US
Telephone Number	:	229-432-8450
Fax Number	:

Provider Business Practice Location Address
First Line	:	1909 ABERDEEN RD
Second Line	:	STE 106
City	:	ALBANY
State	:	GA
Zip	:	31701-1393
Country	:	US
Telephone Number	:	229-432-8450
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	MARK PICKETT
Credential	:
Telephone Number	:	229-432-8450

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	08/22/2020

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