MEDICARE: COMPREHENSIVE NEUROLOGY SPECIALIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	30084	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053427542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE NEUROLOGY SPECIALIST

Provider Business Mailing Address
First Line	:	4275 JOHNS CREEK PKWY
Second Line	:	SUITE C
City	:	SUWANEE
State	:	GA
Zip	:	30024-6038
Country	:	US
Telephone Number	:	770-454-4685
Fax Number	:	770-454-4690

Provider Business Practice Location Address
First Line	:	4275 JOHNS CREEK PKWY
Second Line	:	SUITE C
City	:	SUWANEE
State	:	GA
Zip	:	30024-6038
Country	:	US
Telephone Number	:	770-454-4685
Fax Number	:	770-454-4690

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	DR. MARK I HARRIS
Credential	:	MD
Telephone Number	:	770-454-4685

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	11/01/2007

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Directions to “COMPREHENSIVE NEUROLOGY SPECIALIST ” Practice Location

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