Healthcare Provider Details

I. General information

NPI: 1891860680
Provider Name (Legal Business Name): CHILD NEUROLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 PEACHTREE DUNWOODY RD NE SUITE 500
ATLANTA GA
30342-1705
US

IV. Provider business mailing address

5505 PEACHTREE DUNWOODY RD NE SUITE 500
ATLANTA GA
30342-1705
US

V. Phone/Fax

Practice location:
  • Phone: 404-256-3535
  • Fax: 404-847-1011
Mailing address:
  • Phone: 404-256-3535
  • Fax: 404-847-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GISELLE BERNARD
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 404-256-6904