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General NPI Number Information
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NPI Number | 1225314982
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Entity Type | Organization
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Legal Business Name | NEUROLOGY ASSOCIATES, P.C.
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Dates
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Enumeration Date | 10/26/2011
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Last Update Date | 03/29/2018
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Provider Practice Location Address
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Address Line | 1250 HIGHWAY 54 WEST SUITE 201
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City | FAYETTEVILLE
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State | GA
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Zip | 30214
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Country | US
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Telephone | 770-716-1562
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Fax | 770-716-0145
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Provider Business Mailing Address
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Address Line | 115 SUMNER RD FL 2
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-4758
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Country | US
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Telephone | 770-716-1562
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Fax | 770-716-0145
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Authorized Official
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Title or Position | OWNER OPERATOR
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Name | DR. VIRENDRA V. RANADIVE
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Credential | M.D.
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Telephone | 770-716-1562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 047510
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License Number State | GA
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