Provider Demographics
NPI:1922204361
Name:NEUROLOGY SPECIALISTS OF GEORGIA, P.C.
Entity type:Organization
Organization Name:NEUROLOGY SPECIALISTS OF GEORGIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:770-771-6916
Mailing Address - Street 1:1498 JESSE JEWELL PKWY SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3852
Mailing Address - Country:US
Mailing Address - Phone:770-771-6916
Mailing Address - Fax:
Practice Address - Street 1:1498 JESSE JEWELL PKWY SE
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3852
Practice Address - Country:US
Practice Address - Phone:770-771-6916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041890261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000707462EMedicaid
GA000707462EMedicaid