| Lakeside Neurology, Pc | |
|
1100 Northside Forsyth Dr Ste 440 Cumming GA 30041-6015 | |
| (678) 772-4422 | |
| Not Available |
| Full Name | Lakeside Neurology, Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1100 Northside Forsyth Dr Ste 440, Cumming, Georgia |
| Authorized Official Name and Position | Frank Puhalovich (PRESIDENT) |
| Authorized Official Contact | 6787724422 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Neurology, Pc 1100 Northside Forsyth Dr Ste 440 Cumming GA 30041-6015 Ph: () - | Lakeside Neurology, Pc 1100 Northside Forsyth Dr Ste 440 Cumming GA 30041-6015 Ph: (678) 772-4422 |
| NPI Number | 1386172229 |
|---|---|
| Provider Enumeration Date | 05/23/2017 |
| Last Update Date | 07/06/2023 |
| Certification Date | 07/06/2023 |
| Medicare PECOS PAC ID | 0143584250 |
|---|---|
| Medicare Enrollment ID | O20180425002033 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386172229 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Peter R Futrell |
|---|---|
| Provider Type | Practitioner - Neuropsychiatry |
| Provider Identifiers | NPI Number: 1912990391 PECOS PAC ID: 8921287707 Enrollment ID: I20110126000008 |
| Provider Name | Frank Puhalovich |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1548253941 PECOS PAC ID: 4082893862 Enrollment ID: I20110126000039 |
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