Healthcare Provider Details

I. General information

NPI: 1679513865
Provider Name (Legal Business Name): JEREMY NEIL MEISEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1579 MONROE DR NE STE F STE F 602
ATLANTA GA
30324-5022
US

IV. Provider business mailing address

1579 MONROE DR NE STE F STE F 602
ATLANTA GA
30324-5022
US

V. Phone/Fax

Practice location:
  • Phone: 215-243-2938
  • Fax:
Mailing address:
  • Phone: 215-243-2938
  • Fax: 215-243-2938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number220035
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD 425502
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number10177
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number052786
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: