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NPI Code Detail

MEDICARE: INTENSIVE NEUROMONITORING LLC

MEDICARE: INTENSIVE NEUROMONITORING 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
12084N0400XNeurology Physician69752GA

General Provider Information

NPI Number : 1457722209
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTENSIVE NEUROMONITORING LLC
Provider Business Mailing Address
First Line : 2152 SPRING CREEK RD
Second Line :
City : DECATUR
State : GA
Zip : 30033-2608
Country : US
Telephone Number : 404-831-8168
Fax Number :
Provider Business Practice Location Address
First Line : 2152 SPRING CREEK RD
Second Line :
City : DECATUR
State : GA
Zip : 30033-2608
Country : US
Telephone Number : 404-831-8168
Fax Number :
Authorized Official
Title or Position : OWNER - MANAGING OFFICER
Name : ERIC ROBERT ANDERSON
Credential : MD, PHD
Telephone Number : 404-831-8168
Provider Enumeration Date : 10/19/2015
Last Update Date : 06/29/2016

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Directions to “INTENSIVE NEUROMONITORING LLC ” Practice Location

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