Southern Crescent Neurological Clinic,PC

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

031058 Issued in GA

Legal business name

SOUTHERN CRESCENT NEUROLOGICAL CLINIC,PC

Practice address

1250 Highway 54 W
102
Fayetteville, GA 30214-4545

Phone

(770) 719-2965

Fax

(770) 719-2963

NPI assigned

Feb 20, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kenneth Jay Lazarus, M.D. ,P.H.D.

Title

Ceo

Phone

(770) 719-2965

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sarah Annalise Estrada

  • Medical Physician Assistant
  • Chamblee, GA
  • NPI 1295394237

  Single Specialty

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1013052182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 HIGHWAY 54 W",
            "address_2": "102",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144545",
            "telephone_number": "770-719-2965",
            "fax_number": "770-719-2963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 HIGHWAY 54 W",
            "address_2": "102",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144545",
            "telephone_number": "770-719-2965",
            "fax_number": "770-719-2963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CRESCENT NEUROLOGICAL CLINIC,PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "LAZARUS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-719-2965",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D. ,P.H.D."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "GA",
            "license": "031058",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000406795D",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE FACILITY ID",
            "identifier": "GRP2807",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• South Atlanta Spine and Wellness Center
• South Atlanta Surgical Assistants
• South Regional Surgical Services
• Southeast Georgia Injury Centers
• Southern Behavioral Healthcare,P.C
• Southern Crescent Physical Therapy
• Southern Crescent Physicians Group, Inc.
• Southern Crescent Women'S Healthcare PC
• Southern Neighbor Medical Transport LLC
• Southern Pain Institute P C

• All providers in Fayetteville, GA
• Neurology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.