Basic Information
| Provider Information | |||||||||
| NPI: | 1578726584 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEDIATRIC NEUROSURGERY ASSOCIATES @ CHILDREN'S HEALTHCARE OF ATLANTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5455 MERIDIAN MARKS RD NE | ||||||||
| Address2: | SUITE 540 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042556509 | ||||||||
| FaxNumber: | 4042551686 | ||||||||
| Practice Location | |||||||||
| Address1: | 5455 MERIDIAN MARKS RD NE | ||||||||
| Address2: | SUITE 540 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042556509 | ||||||||
| FaxNumber: | 4042551686 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2008 | ||||||||
| LastUpdateDate: | 07/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | GREINER | ||||||||
| AuthorizedOfficialFirstName: | CINDY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4042566153 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | RN174021 NP | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.