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NPI Code Detail

MEDICARE: NICLAIRE LYNN NEELY MD

MEDICARE: NICLAIRE LYNN NEELY MD
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
12084P0800XPsychiatry Physician11016023AIN
22084P0800XPsychiatry Physician74202GA

General Provider Information

NPI Number : 1730478629
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICLAIRE LYNN NEELY MD
Provider Business Mailing Address
First Line : 3225 SHALLOWFORD RD STE 500
Second Line :
City : MARIETTA
State : GA
Zip : 30062-7024
Country : US
Telephone Number : 678-757-4576
Fax Number : 605-309-8118
Provider Business Practice Location Address
First Line : 3225 SHALLOWFORD RD STE 500
Second Line :
City : MARIETTA
State : GA
Zip : 30062-7024
Country : US
Telephone Number : 678-757-4576
Fax Number : 605-309-8118
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2011
Last Update Date : 12/30/2021

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