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General NPI Number Information
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NPI Number | 1760900708
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Entity Type | Organization
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Legal Business Name | NEURO DIAGNOSTIC GROUP LLC
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Dates
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Enumeration Date | 08/30/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 200 GALLERIA PKWY SE STE 100
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City | ATLANTA
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State | GA
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Zip | 30339-5944
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Country | US
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Telephone | 855-411-2225
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Fax | 800-886-1731
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Provider Business Mailing Address
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Address Line | 200 GALLERIA PKWY SE STE 100
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City | ATLANTA
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State | GA
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Zip | 30339-5944
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Country | US
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Telephone | 855-411-2225
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Fax | 800-886-1731
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Authorized Official
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Title or Position | CEO
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Name | DR. OFFER DANAN
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Credential | DC
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Telephone | 770-695-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 59870
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License Number State | GA
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