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General NPI Number Information
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NPI Number | 1699063651
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Entity Type | Organization
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Legal Business Name | MAYVILLE NEUROLOGY
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Dates
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Enumeration Date | 07/12/2011
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Last Update Date | 03/06/2012
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Provider Practice Location Address
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Address Line | 1100 JOHNSON FERRY RD NE CENTERPOINT BLDG I, SUITE 425
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City | ATLANTA
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State | GA
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Zip | 30342-1709
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Country | US
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Telephone | 404-252-2666
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Fax | 404-252-0890
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Provider Business Mailing Address
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Address Line | 1100 JOHNSON FERRY RD NE CENTERPOINT BLDG I, SUITE 425
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City | ATLANTA
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State | GA
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Zip | 30342-1709
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Country | US
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Telephone | 404-252-2666
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Fax | 404-252-0890
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Authorized Official
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Title or Position | CEO
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Name | DR. CHRISTINA L MAYVILLE
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Credential | M.D.
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Telephone | 404-252-2666
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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 | 043423
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License Number State | GA
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