Healthcare Provider Details

I. General information

NPI: 1821297474
Provider Name (Legal Business Name): ATLANTA FAMILY NEUROLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 JOHNSON FERRY RD NE STE 360
ATLANTA GA
30342-1619
US

IV. Provider business mailing address

975 JOHNSON FERRY RD NE STE 360
ATLANTA GA
30342-1619
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-0219
  • Fax:
Mailing address:
  • Phone: 404-252-0219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number014563
License Number StateGA

VIII. Authorized Official

Name: DR. GERALD SILVERBOARD
Title or Position: PHYSICIAN/OWNER
Credential:
Phone: 404-252-0219