Basic Information
| Provider Information | |||||||||
| NPI: | 1407869407 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIDTOWN NEUROLOGY, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 285 BOULEVARD NE STE 610 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303124212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4046530039 | ||||||||
| FaxNumber: | 4046530159 | ||||||||
| Practice Location | |||||||||
| Address1: | 285 BOULEVARD NE STE 610 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303124212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4046530039 | ||||||||
| FaxNumber: | 4046530159 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 08/24/2022 | ||||||||
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| AuthorizedOfficialLastName: | MISHU | ||||||||
| AuthorizedOfficialFirstName: | HUSHAM | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4046530039 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.