Provider Demographics
NPI:1285235036
Name:NEIGHBORMD OF SOUTH ATLANTA LLC
Entity type:Organization
Organization Name:NEIGHBORMD OF SOUTH ATLANTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMANELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-459-3661
Mailing Address - Street 1:3885 PRINCETON LAKES WAY SW STE 412
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-5599
Mailing Address - Country:US
Mailing Address - Phone:404-344-6000
Mailing Address - Fax:404-344-6575
Practice Address - Street 1:3885 PRINCETON LAKES WAY SW STE 412
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-5599
Practice Address - Country:US
Practice Address - Phone:404-344-6000
Practice Address - Fax:404-344-6575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-06
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty