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General NPI Number Information
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NPI Number | 1609385533
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Entity Type | Organization
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Legal Business Name | PEACHTREE NEUROMONITORING, LLC
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Dates
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Enumeration Date | 09/22/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 925B PEACHTREE ST NE STE 750
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City | ATLANTA
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State | GA
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Zip | 30309-3918
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Country | US
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Telephone | 361-866-3876
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Fax |
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Provider Business Mailing Address
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Address Line | 925B PEACHTREE ST NE STE 750
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City | ATLANTA
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State | GA
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Zip | 30309-3918
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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 | VP FINANCE & BILLING
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Name | DOREEN SHINN
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Credential |
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Telephone | 361-866-3876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204R00000X
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Taxonomy Name | Electrodiagnostic Medicine Physician
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License Number |
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License Number State |
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