Southern Crescent Neurological Clinic,pc
Psychiatry & Neurology, Neurology in Fayetteville, GA. Organization (NPI-2).
NPI number1013052182
StatusActive
Last updated in NPPESJun 21, 2018
Details
- NPI
- 1013052182
- Entity type
- Organization (NPI-2)
- Legal business name
- Southern Crescent Neurological Clinic,pc
- Organization subpart
- No
- Enumeration date
- Feb 20, 2007
- Last updated
- Jun 21, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology, Neurology | 031058 | GA | Yes |
Practice location
1250 Highway 54 W102
Fayetteville, GA 30214-4545
Phone 770-719-2965 · Fax 770-719-2963
Mailing address
1250 Highway 54 W102
Fayetteville, GA 30214-4545
Phone 770-719-2965 · Fax 770-719-2963
Authorized official
Kenneth Jay Lazarus
Ceo
7707192965
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