Provider Demographics
NPI:1902799695
Name:ADVANCE COGNITIVE CARE LLC
Entity type:Organization
Organization Name:ADVANCE COGNITIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-316-7159
Mailing Address - Street 1:4666 RANDALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-4350
Mailing Address - Country:US
Mailing Address - Phone:770-670-0540
Mailing Address - Fax:770-670-0540
Practice Address - Street 1:4666 RANDALWOOD DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-4350
Practice Address - Country:US
Practice Address - Phone:770-670-0540
Practice Address - Fax:770-670-0540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-31
Last Update Date:2025-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty