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General NPI Number Information
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NPI Number | 1861961427
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Entity Type | Organization
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Legal Business Name | LIVE OAK NEUROLOGY LLC
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Dates
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Enumeration Date | 11/13/2018
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Last Update Date | 11/13/2018
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Provider Practice Location Address
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Address Line | 850 DOGWOOD RD STE B2002002
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-7218
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Country | US
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Telephone | 404-900-9540
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Fax |
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Provider Business Mailing Address
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Address Line | 850 DOGWOOD RD STE B2002002
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-7218
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP
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Name | DOREEN SHINN
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Credential |
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Telephone | 609-380-3305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204R00000X
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Taxonomy Name | Electrodiagnostic Medicine Physician
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License Number |
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License Number State |
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