Healthcare Provider Details

I. General information

NPI: 1730715046
Provider Name (Legal Business Name): NATHANIEL NEPTUNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE
ATLANTA GA
30308-2212
US

IV. Provider business mailing address

550 PEACHTREE ST NE
ATLANTA GA
30308-2212
US

V. Phone/Fax

Practice location:
  • Phone: 404-686-1424
  • Fax: 404-778-2109
Mailing address:
  • Phone: 404-686-1424
  • Fax: 404-778-2109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number13245
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: