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General NPI Number Information
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NPI Number | 1073598488
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Entity Type | Organization
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Legal Business Name | MARIETTA NEUROLOGY AND HEADACHE CENTER, PC
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Dates
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Enumeration Date | 12/08/2005
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Last Update Date | 06/07/2013
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Provider Practice Location Address
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Address Line | 780 CANTON RD STE 400
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City | MARIETTA
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State | GA
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Zip | 30060-7298
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Country | US
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Telephone | 770-422-3602
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Fax | 770-421-6115
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Provider Business Mailing Address
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Address Line | 780 CANTON RD STE 400
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City | MARIETTA
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State | GA
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Zip | 30060-7298
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Country | US
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Telephone | 770-422-3602
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Fax | 770-421-6115
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Authorized Official
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Title or Position | MD MANAGING PARTNER
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Name | DR. THOMAS M HOLMES
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Credential | MD
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Telephone | 770-422-3602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number |
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License Number State |
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