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General NPI Number Information
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NPI Number | 1336353093
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN NEUROLOGY ASSOCIATES,LLC
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 10/27/2014
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Provider Practice Location Address
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Address Line | 5211 HIGHWAY 278 NE
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City | COVINGTON
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State | GA
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Zip | 30014-2671
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Country | US
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Telephone | 770-787-8210
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Fax | 770-787-8228
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Provider Business Mailing Address
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Address Line | 5211 HIGHWAY 278 NE
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City | COVINGTON
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State | GA
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Zip | 30014-2671
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Country | US
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Telephone | 770-787-8210
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Fax | 770-787-8228
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. CLAUDIA J WEAVER
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Credential |
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Telephone | 770-787-8200
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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 | 043773
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN120924-NP
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 56605
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License Number State | GA
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