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General NPI Number Information
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NPI Number | 1801926381
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Entity Type | Organization
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Legal Business Name | SUMNER NEUROLOGY ASSOCIATES, PLLC
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 11/01/2012
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Provider Practice Location Address
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Address Line | 1000 JOHNSON FERRY RD BLDG F STE.120
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City | MARIETTA
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State | GA
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Zip | 30068-2114
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Country | US
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Telephone | 678-402-1053
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Fax | 678-402-5619
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Provider Business Mailing Address
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Address Line | PO BOX 680010
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City | MARIETTA
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State | GA
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Zip | 30068-0001
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Country | US
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Telephone | 678-402-1053
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Fax | 678-402-5619
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAWAID AHSAN
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Credential | M.D.
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Telephone | 678-402-1053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 16896
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License Number State | TN
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