MEDICARE: NEIGHBORMD OF SOUTH ATLANTA LLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1285235036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEIGHBORMD OF SOUTH ATLANTA LLC

Provider Business Mailing Address
First Line	:	3885 PRINCETON LAKES WAY SW STE 412
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-5599
Country	:	US
Telephone Number	:	404-344-6000
Fax Number	:	404-344-6575

Provider Business Practice Location Address
First Line	:	3885 PRINCETON LAKES WAY SW STE 412
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-5599
Country	:	US
Telephone Number	:	404-344-6000
Fax Number	:	404-344-6575

Authorized Official
Title or Position	:	COO
Name	:	DAVID ROMANELLO
Credential	:
Telephone Number	:	352-459-3661

Provider Enumeration Date	:	11/06/2020
Last Update Date	:	08/19/2021

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