| Sumner Neurology Associates, Pllc | |
|
1000 Johnson Ferry Rd Bldg F Ste.120 Marietta GA 30068-2114 | |
| (678) 402-1053 | |
| (678) 402-5619 |
| Full Name | Sumner Neurology Associates, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1000 Johnson Ferry Rd Bldg F, Marietta, Georgia |
| Authorized Official Name and Position | Jawaid Ahsan (OWNER) |
| Authorized Official Contact | 6784021053 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sumner Neurology Associates, Pllc Po Box 680010 Marietta GA 30068-0001 Ph: (678) 402-1053 | Sumner Neurology Associates, Pllc 1000 Johnson Ferry Rd Bldg F Ste.120 Marietta GA 30068-2114 Ph: (678) 402-1053 |
| NPI Number | 1801926381 |
|---|---|
| Provider Enumeration Date | 03/06/2007 |
| Last Update Date | 11/01/2012 |
| Medicare PECOS PAC ID | 5395839302 |
|---|---|
| Medicare Enrollment ID | O20101229000406 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801926381 | NPI | - | NPPES |
| 871643718A | Medicaid | GA | |
| 871643718A | Medicaid | TN | |
| FA1875624 | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | 16896 (Tennessee) | Primary |
| Provider Name | Jawaid Ahsan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1578618815 PECOS PAC ID: 9739265497 Enrollment ID: I20101229000490 |
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