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General NPI Number Information
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NPI Number | 1356959969
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Entity Type | Organization
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Legal Business Name | ADVANCED NEUROSURGERY ASSOCIATES LLC
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Dates
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Enumeration Date | 07/20/2020
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 631 PROFESSIONAL DR STE 360
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-3370
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Country | US
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Telephone | 404-851-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 JOHNSON FERRY ROAD ATTN: JORGE HERNANDEZ
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City | ATLANTA
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State | GA
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Zip | 30342-1611
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CCO
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Name | MR. JORGE HERNANDEZ
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Credential |
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Telephone | 404-851-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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