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General NPI Number Information
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NPI Number | 1225329667
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Entity Type | Organization
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Legal Business Name | ALCOVY NEUROLOGY
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Dates
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Enumeration Date | 04/20/2011
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 3525 HIGHWAY 81
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City | LOGANVILLE
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State | GA
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Zip | 30052-4336
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Country | US
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Telephone | 678-905-9625
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Fax | 770-674-5880
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Provider Business Mailing Address
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Address Line | 3525 HIGHWAY 81
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City | LOGANVILLE
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State | GA
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Zip | 30052-4336
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Country | US
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Telephone | 678-905-9625
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Fax | 770-674-5880
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Authorized Official
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Title or Position | NEUROLOGIST
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Name | JUAN CARLOS LACAYO
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Credential | MD
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Telephone | 678-905-9625
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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