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General NPI Number Information
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NPI Number | 1841732138
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Entity Type | Organization
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Legal Business Name | SUNRISE PEDIATRIC NEUROLOGY
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Dates
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Enumeration Date | 11/17/2016
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Last Update Date | 11/17/2016
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Provider Practice Location Address
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Address Line | 3417 CANTON RD BUILDING1
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City | MARIETTA
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State | GA
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Zip | 30066-2896
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Country | US
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Telephone | 678-606-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 3417 CANTON RD BUILDING 1
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City | MARIETTA
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State | GA
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Zip | 30066-2896
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Country | US
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Telephone | 678-606-5700
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHERISE FRAZIER
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Credential |
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Telephone | 678-606-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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