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General NPI Number Information
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NPI Number | 1740317346
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Entity Type | Organization
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Legal Business Name | ATLANTA NEUROMUSCULAR DIAGNOSTICS, LLC
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 550 PEACHTREE ST NE STE 1575
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City | ATLANTA
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State | GA
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Zip | 30308-2254
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Country | US
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Telephone | 404-586-0442
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Fax | 404-586-0520
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Provider Business Mailing Address
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Address Line | PO BOX 54145
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City | ATLANTA
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State | GA
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Zip | 30308-0145
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Country | US
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Telephone | 404-586-0442
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Fax | 404-586-0520
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | JACQUELINE M WASHINGTON
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Credential | MD
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Telephone | 404-586-0442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 032493
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License Number State | GA
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