MEDICARE: CARTERSVILLE NEUROLOGY, 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	2084N0400X	Neurology Physician	054983	GA

General Provider Information

NPI Number	:	1386707198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARTERSVILLE NEUROLOGY, P.C.

Provider Business Mailing Address
First Line	:	100 MARKET PLACE BLVD
Second Line	:
City	:	CARTERSVILLE
State	:	GA
Zip	:	30121-8718
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 MARKET PLACE BLVD
Second Line	:
City	:	CARTERSVILLE
State	:	GA
Zip	:	30121-8718
Country	:	US
Telephone Number	:	770-862-6146
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	CECILY FRANK COLE
Credential	:	M.D.
Telephone Number	:	770-862-6146

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	08/22/2020

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