MEDICARE: SPORTS CONCUSSION INSTITUTE AT ATLANTA

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	048624	GA

General Provider Information

NPI Number	:	1164774527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPORTS CONCUSSION INSTITUTE AT ATLANTA

Provider Business Mailing Address
First Line	:	3200 DOWNWOOD CIR NW
Second Line	:	SUITE 430
City	:	ATLANTA
State	:	GA
Zip	:	30327-1659
Country	:	US
Telephone Number	:	404-856-4848
Fax Number	:	404-963-6572

Provider Business Practice Location Address
First Line	:	3200 DOWNWOOD CIR NW
Second Line	:	SUITE 430
City	:	ATLANTA
State	:	GA
Zip	:	30327-1659
Country	:	US
Telephone Number	:	404-856-4848
Fax Number	:	404-963-6572

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEFFREY ENGLISH
Credential	:	M.D.
Telephone Number	:	404-856-4848

Provider Enumeration Date	:	10/10/2012
Last Update Date	:	10/10/2012

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