Healthcare Provider Details

I. General information

NPI: 1487133740
Provider Name (Legal Business Name): EVOKED IONM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6458 MERIDIAN WAY
SANDY SPRINGS GA
30328-2895
US

IV. Provider business mailing address

6458 MERIDIAN WAY
SANDY SPRINGS GA
30328-2895
US

V. Phone/Fax

Practice location:
  • Phone: 678-524-7388
  • Fax: 470-407-6969
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: AMIT SHAH
Title or Position: PRESIDENT, CHIEF MEDICAL OFFICER
Credential:
Phone: 678-524-7388