MEDICARE: ATLANTA NEUROMUSCULAR DIAGNOSTICS, 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	2084N0400X	Neurology Physician	032493	GA

General Provider Information

NPI Number	:	1740317346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTA NEUROMUSCULAR DIAGNOSTICS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 54145
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-0145
Country	:	US
Telephone Number	:	404-586-0442
Fax Number	:	404-586-0520

Provider Business Practice Location Address
First Line	:	550 PEACHTREE ST NE STE 1575
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2254
Country	:	US
Telephone Number	:	404-586-0442
Fax Number	:	404-586-0520

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	JACQUELINE M WASHINGTON
Credential	:	MD
Telephone Number	:	404-586-0442

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	08/22/2020

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