Provider Demographics
NPI:1427430412
Name:GEORGIA DISC AND NEUROPATHY PC
Entity type:Organization
Organization Name:GEORGIA DISC AND NEUROPATHY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:770-262-0171
Mailing Address - Street 1:197 14TH ST NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-7815
Mailing Address - Country:US
Mailing Address - Phone:404-343-1649
Mailing Address - Fax:404-343-6615
Practice Address - Street 1:197 14TH ST NW
Practice Address - Street 2:SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-7815
Practice Address - Country:US
Practice Address - Phone:404-343-1649
Practice Address - Fax:404-343-6615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033643174400000X
GA033543302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF09571Medicare UPIN