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General NPI Number Information
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NPI Number | 1265435242
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Entity Type | Individual
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Provider Name | NEIL JAY NEGRIN MD
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Gender | Male
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 04/25/2012
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Provider Practice Location Address
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Address Line | 3875 AUSTELL RD. STE 201
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City | AUSTELL
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State | GA
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Zip | 30106-1153
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Country | US
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Telephone | 770-819-1777
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Fax | 770-819-1730
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Provider Business Mailing Address
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Address Line | 3875 AUSTELL RD STE 201
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City | AUSTELL
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State | GA
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Zip | 30106-1103
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Country | US
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Telephone | 770-819-1777
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Fax | 770-819-1730
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 22610
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License Number State | GA
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