MEDICARE: NEUROLIVE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number
1	2084N0400X	Neurology Physician	32943
2	246ZE0600X	Electroneurodiagnostic Specialist/Technologist	32943
3	246Z00000X	Other Specialist/Technologist

General Provider Information

NPI Number	:	1841431459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROLIVE LLC

Provider Business Mailing Address
First Line	:	PO BOX 646
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30301-0646
Country	:	US
Telephone Number	:	770-443-4483
Fax Number	:	770-443-4410

Provider Business Practice Location Address
First Line	:	1266 W PACES FERRY RD NW STE 646
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-2306
Country	:	US
Telephone Number	:	770-443-4483
Fax Number	:	110-443-4410

Authorized Official
Title or Position	:	ACCOUNT MANAGER
Name	:	MONICA DAVIS
Credential	:
Telephone Number	:	770-443-4483

Provider Enumeration Date	:	03/11/2009
Last Update Date	:	03/11/2009

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