Healthcare Provider Details

I. General information

NPI: 1205370459
Provider Name (Legal Business Name): NEUROLOGICAL CENTER OF NORTH GEORGIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 JESSE JEWELL PKWY NE STE 240A
GAINESVILLE GA
30501-3801
US

IV. Provider business mailing address

PO BOX 908621
GAINESVILLE GA
30501-0926
US

V. Phone/Fax

Practice location:
  • Phone: 678-961-0733
  • Fax:
Mailing address:
  • Phone: 678-961-0733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL LAMAR COBB
Title or Position: CEO/OWNER
Credential: MD
Phone: 678-961-0733