Healthcare Provider Details

I. General information

NPI: 1407869407
Provider Name (Legal Business Name): MIDTOWN NEUROLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 BOULEVARD NE STE 610
ATLANTA GA
30312-4212
US

IV. Provider business mailing address

285 BOULEVARD NE STE 610
ATLANTA GA
30312-4212
US

V. Phone/Fax

Practice location:
  • Phone: 404-653-0039
  • Fax: 404-653-0159
Mailing address:
  • Phone: 404-653-0039
  • Fax: 404-653-0159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HUSHAM P MISHU
Title or Position: OWNER
Credential:
Phone: 404-653-0039