=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265192090
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNITED NEUROLOGY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2021
-----------------------------------------------------
Last Update Date | 12/21/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1266 W PACES FERRY RD NW STE 332
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30327-2306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-528-0028
-----------------------------------------------------
Fax | 770-528-0029
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1266 W PACES FERRY RD NW STE 332
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30327-2306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-528-0028
-----------------------------------------------------
Fax | 770-528-0029
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | MS. LUCY THOMAS
-----------------------------------------------------
Credential | CPB
-----------------------------------------------------
Telephone | 678-428-7812
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------