Healthcare Provider Details

I. General information

NPI: 1831488485
Provider Name (Legal Business Name): NEUROPHYSIOLOGY LABORATORIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 PEACHTREE ST STE 2200
ATLANTA GA
30303-1292
US

IV. Provider business mailing address

PO BOX 2259
GRIFFIN GA
30224-0057
US

V. Phone/Fax

Practice location:
  • Phone: 404-419-1319
  • Fax:
Mailing address:
  • Phone: 404-419-1319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number639
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number639
License Number StateGA

VIII. Authorized Official

Name: MR. ATEER SHETH
Title or Position: SOLE MBR
Credential:
Phone: 404-642-0259