NPIMap

Organization Active NPI

Newnan Neurology PC

  • Neurology Physician
  • Newnan, GA
National Provider Identifier
1104231240
Registry record updated Jul 1, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
57404 Issued in GA
Legal business name
NEWNAN NEUROLOGY PC
Practice address
60 Oak Hill Blvd
Suite 103
Newnan, GA 30265-2314
Phone
(770) 683-8637
Fax
(770) 683-8633
NPI assigned
Jun 27, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2014

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

Authorized official

Name
Dr. Qing Ni, MDNPI 1295765311
Title
Owner
Phone
(770) 683-8637

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084N0400X 57404 GA Primary

Addresses

Primary practice location

60 Oak Hill Blvd
Suite 103
Newnan, GA 30265-2314

Mailing address

60 Oak Hill Blvd
Suite 103
Newnan, GA 30265-2314
Phone (770) 683-8637

Other identifiers 2

IdentifierTypeStateIssuer
639314016MedicaidGA
646750194AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140807002283 GA Part B Supplier - Clinic/Group Practice 9830316223 Receives reassigned benefits from 2 practitioners
Practice locations: Newnan, GA
O20250418000422 GA DME Supplier - Physician - Neurology 9830316223 Practice locations: Newnan, GA

National Provider Directory

National Provider Directory

Locations

60 Oak Hill Blvd
Ste 103
Newnan, GA 30265
Phone (770) 683-8637

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1403827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404172800000",
    "number": "1104231240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 OAK HILL BLVD",
            "address_2": "SUITE 103",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302652314",
            "telephone_number": "770-683-8637",
            "fax_number": "770-683-8633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 OAK HILL BLVD",
            "address_2": "SUITE 103",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302652314",
            "telephone_number": "770-683-8637",
            "fax_number": "770-683-8633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEWNAN NEUROLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-27",
        "last_updated": "2014-07-01",
        "status": "A",
        "authorized_official_last_name": "NI",
        "authorized_official_first_name": "QING",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-683-8637",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "GA",
            "license": "57404",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "639314016",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "646750194A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newnan, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.