MEDICARE: NEUROLOGY ASSOCIATES, P.C.

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	174400000X	Specialist	047510	GA

General Provider Information

NPI Number	:	1225314982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROLOGY ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	115 SUMNER RD FL 2
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-4758
Country	:	US
Telephone Number	:	770-716-1562
Fax Number	:	770-716-0145

Provider Business Practice Location Address
First Line	:	1250 HIGHWAY 54 WEST
Second Line	:	SUITE 201
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214
Country	:	US
Telephone Number	:	770-716-1562
Fax Number	:	770-716-0145

Authorized Official
Title or Position	:	OWNER OPERATOR
Name	:	DR. VIRENDRA V. RANADIVE
Credential	:	M.D.
Telephone Number	:	770-716-1562

Provider Enumeration Date	:	10/26/2011
Last Update Date	:	03/29/2018

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