Provider Demographics
NPI:1124239868
Name:GEORGIA NEUROLOGY, LLC
Entity type:Organization
Organization Name:GEORGIA NEUROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-267-1159
Mailing Address - Street 1:700 BREEDLOVE DR STE D
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-2064
Mailing Address - Country:US
Mailing Address - Phone:770-267-1159
Mailing Address - Fax:
Practice Address - Street 1:700 BREEDLOVE DR STE D
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2064
Practice Address - Country:US
Practice Address - Phone:770-267-1159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI43312Medicare UPIN
GAGRP7363Medicare ID - Type Unspecified