Provider Demographics
NPI:1083669824
Name:ALBANY NEUROSURGERY CENTER
Entity type:Organization
Organization Name:ALBANY NEUROSURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-762-5037
Mailing Address - Street 1:1909 ABERDEEN RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1393
Mailing Address - Country:US
Mailing Address - Phone:229-432-8450
Mailing Address - Fax:229-432-8451
Practice Address - Street 1:1909 ABERDEEN RD
Practice Address - Street 2:SUITE 106
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1393
Practice Address - Country:US
Practice Address - Phone:229-432-8450
Practice Address - Fax:229-432-8451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADF3566OtherRAILROAD MEDICARE
GADF3566OtherRAILROAD MEDICARE
GAGRP7742Medicare PIN