Basic Information
| Provider Information | |||||||||
| NPI: | 1619195781 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATLANTIC NEUROLOGY, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3515 TRENT RD | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | NEW BERN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285622220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526727731 | ||||||||
| FaxNumber: | 2526727758 | ||||||||
| Practice Location | |||||||||
| Address1: | 3515 TRENT RD | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | NEW BERN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285622220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526727731 | ||||||||
| FaxNumber: | 2526727758 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2007 | ||||||||
| LastUpdateDate: | 09/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | STEEL | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | GRIFFITH | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2526377860 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 200001220986 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 1659364156 | 01 | NC | NPI | OTHER |