Basic Information
| Provider Information | |||||||||
| NPI: | 1174740344 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | GROSSBERG | ||||||||
| FirstName: | JONATHAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPARTMENT OF NEUROSURGERY | ||||||||
| Address2: | 1365 CLIFTON RD, NE | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303220001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047785000 | ||||||||
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| Practice Location | |||||||||
| Address1: | DEPARTMENT OF NEUROSURGERY | ||||||||
| Address2: | 1365 CLIFTON RD, NE | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303220001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047785000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2007 | ||||||||
| LastUpdateDate: | 07/10/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | LP00899 | RI | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 069603 | GA | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.