| Neurology South Pc | |
|
1050 Eagles Landing Pkwy Ste 203 Stockbridge GA 30281 | |
| (770) 474-4875 | |
| (770) 474-1469 |
| Full Name | Neurology South Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1050 Eagles Landing Pkwy, Stockbridge, Georgia |
| Authorized Official Name and Position | Raghuram Kolanu (PRESIDENT) |
| Authorized Official Contact | 7704744875 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Neurology South Pc Po Box 2877 Stockbridge GA 30281 Ph: (770) 474-4875 | Neurology South Pc 1050 Eagles Landing Pkwy Ste 203 Stockbridge GA 30281 Ph: (770) 474-4875 |
| NPI Number | 1861530016 |
|---|---|
| Provider Enumeration Date | 02/01/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 9032167556 |
|---|---|
| Medicare Enrollment ID | O20050111000437 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861530016 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Raghuram Kolanu |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1740328996 PECOS PAC ID: 1658329172 Enrollment ID: I20050112000429 |
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