MEDICARE: ALBANY NEUROSURGERY CENTER

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	207T00000X	Neurological Surgery Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DF3566	OTHER	GA	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1083669824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALBANY NEUROSURGERY CENTER

Provider Business Mailing Address
First Line	:	1909 ABERDEEN RD
Second Line	:	SUITE 106
City	:	ALBANY
State	:	GA
Zip	:	31701-1393
Country	:	US
Telephone Number	:	229-432-8450
Fax Number	:	229-432-8451

Provider Business Practice Location Address
First Line	:	1909 ABERDEEN RD
Second Line	:	SUITE 106
City	:	ALBANY
State	:	GA
Zip	:	31701-1393
Country	:	US
Telephone Number	:	229-432-8450
Fax Number	:	229-432-8451

Authorized Official
Title or Position	:	VP
Name	:	MARK PICKETT
Credential	:
Telephone Number	:	678-762-5037

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	04/20/2008

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