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General NPI Number Information
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NPI Number | 1205017944
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Entity Type | Organization
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Legal Business Name | CLINICAL NEURO DX, LLC
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Dates
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Enumeration Date | 11/23/2007
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Last Update Date | 04/02/2009
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Provider Practice Location Address
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Address Line | 260 PEACHTREE ST NW STE 2200
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City | ATLANTA
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State | GA
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Zip | 30303-1292
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Country | US
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Telephone | 404-419-1319
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2259
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City | GRIFFIN
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State | GA
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Zip | 30224-0057
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Country | US
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Telephone | 404-419-1319
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Fax | 866-209-0284
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Authorized Official
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Title or Position | MEMBER, CLINICAL NEUROPHYSIOLOGIST
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Name | MR. ATEER SHETH
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Credential | CNLM, MS
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Telephone | 404-419-1319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 639
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License Number State | NY
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