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General NPI Number Information
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NPI Number | 1205367869
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Entity Type | Organization
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Legal Business Name | CENTER FOR RARE NEUROLOGICAL DISEASES
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Dates
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Enumeration Date | 03/24/2017
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Last Update Date | 03/24/2017
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Provider Practice Location Address
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Address Line | 3985 STEVE REYNOLDS BLVD BLDG O
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City | NORCROSS
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State | GA
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Zip | 30093-3035
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Country | US
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Telephone | 207-590-6945
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Fax |
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Provider Business Mailing Address
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Address Line | 2645 CLAIRMONT RD NE
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City | ATLANTA
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State | GA
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Zip | 30329-2710
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Country | US
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Telephone | 207-590-6945
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANIEL CHARLES TARQUINIO
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Credential | D.O.
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Telephone | 207-590-6945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 72932
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License Number State | GA
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