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General NPI Number Information
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NPI Number | 1164774527
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Entity Type | Organization
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Legal Business Name | SPORTS CONCUSSION INSTITUTE AT ATLANTA
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Dates
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Enumeration Date | 10/10/2012
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Last Update Date | 10/10/2012
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Provider Practice Location Address
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Address Line | 3200 DOWNWOOD CIR NW SUITE 430
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City | ATLANTA
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State | GA
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Zip | 30327-1659
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Country | US
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Telephone | 404-856-4848
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Fax | 404-963-6572
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Provider Business Mailing Address
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Address Line | 3200 DOWNWOOD CIR NW SUITE 430
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City | ATLANTA
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State | GA
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Zip | 30327-1659
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Country | US
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Telephone | 404-856-4848
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Fax | 404-963-6572
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY ENGLISH
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Credential | M.D.
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Telephone | 404-856-4848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 048624
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License Number State | GA
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