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General NPI Number Information
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NPI Number | 1720536584
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Entity Type | Organization
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Legal Business Name | ATLANTA NEURO CARE
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Dates
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Enumeration Date | 09/21/2016
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Last Update Date | 09/21/2016
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Provider Practice Location Address
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Address Line | 1372 WELLBROOK CIR NE
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City | CONYERS
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State | GA
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Zip | 30012-3872
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Country | US
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Telephone | 770-274-3378
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Fax | 770-274-3489
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Provider Business Mailing Address
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Address Line | PO BOX 542
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City | CONYERS
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State | GA
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Zip | 30012-9998
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Country | US
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Telephone | 770-274-3428
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Fax | 770-274-3489
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANIEL TESFAYE
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Credential | MD
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Telephone | 770-274-3378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 67614
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License Number State | GA
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