Healthcare Provider Details

I. General information

NPI: 1801943378
Provider Name (Legal Business Name): SOUTH ATLANTA NEUROLOGY AND DIAGNOSTICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 MEDICAL WAY STE B
RIVERDALE GA
30274-2517
US

IV. Provider business mailing address

203 MEDICAL WAY STE B
RIVERDALE GA
30274-2517
US

V. Phone/Fax

Practice location:
  • Phone: 678-782-5000
  • Fax: 678-289-9448
Mailing address:
  • Phone: 678-782-5000
  • Fax: 678-289-9448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number055757
License Number StateGA

VIII. Authorized Official

Name: SYED S HASAN
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 678-782-5000