Healthcare Provider Details

I. General information

NPI: 1285235036
Provider Name (Legal Business Name): NEIGHBORMD OF SOUTH ATLANTA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3885 PRINCETON LAKES WAY SW STE 412
ATLANTA GA
30331-5599
US

IV. Provider business mailing address

3885 PRINCETON LAKES WAY SW STE 412
ATLANTA GA
30331-5599
US

V. Phone/Fax

Practice location:
  • Phone: 404-344-6000
  • Fax: 404-344-6575
Mailing address:
  • Phone: 404-344-6000
  • Fax: 404-344-6575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID ROMANELLO
Title or Position: COO
Credential:
Phone: 352-459-3661