Healthcare Provider Details

I. General information

NPI: 1356527329
Provider Name (Legal Business Name): ATLANTA CHILD NEUROLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 01/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 JOHNSON FERRY RD NE STE 360
ATLANTA GA
30342-4735
US

IV. Provider business mailing address

975 JOHNSON FERRY RD NE STE 360
ATLANTA GA
30342-4735
US

V. Phone/Fax

Practice location:
  • Phone: 404-255-2670
  • Fax:
Mailing address:
  • Phone: 404-255-2670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number
License Number State

VIII. Authorized Official

Name: GERALD M SILVERBOARD
Title or Position: PRESIDENT
Credential: MD
Phone: 404-255-2670