MEDICARE: NORTH GEORGIA NEUROLOGICAL INSTITUTE

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

General Provider Information

NPI Number	:	1932135183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH GEORGIA NEUROLOGICAL INSTITUTE

Provider Business Mailing Address
First Line	:	1505 PROFESSIONAL CT
Second Line	:
City	:	DALTON
State	:	GA
Zip	:	30720-2500
Country	:	US
Telephone Number	:	706-275-6121
Fax Number	:	706-275-0521

Provider Business Practice Location Address
First Line	:	1505 PROFESSIONAL CT
Second Line	:
City	:	DALTON
State	:	GA
Zip	:	30720-2500
Country	:	US
Telephone Number	:	706-275-6121
Fax Number	:	706-275-0521

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GRACE GILGENAST
Credential	:	MD
Telephone Number	:	706-275-6121

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	09/06/2007

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