Individual provider Active NPI

Robert K Naguszewski, M.D.

  • Neurology Physician
  • Carrollton, GA
National Provider Identifier
1255315016
Registry record updated Dec 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
032792 Issued in GA
Practice address
905 Dixie St
Carrollton, GA 30117-4417
Phone
(770) 812-5831
Fax
(770) 812-5832
NPI assigned
Dec 5, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 032792 GA Primary

Addresses

Primary practice location

905 Dixie St
Carrollton, GA 30117-4417

Mailing address

119 Ambulance Dr.
Suite 202
Carrollton, GA 30117-3856
Phone (770) 838-8787

Other identifiers 2

IdentifierTypeStateIssuer
0004296684MedicaidGA
00429668CMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040518000879 GA Practitioner - NeurologyPractitioner - Internal Medicine 4284624479 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Tanner Medical Group Inc Neurology CurrentSince Jul 1, 2010 Accepting new patients
Rome Wellness Diagnostics Past Accepting new patients
Cartersville Wellness Diagnostics Past Accepting new patients
Coosa Neurology PC Neurology Past Accepting new patients

Locations

119 Ambulance Dr
Ste 202
Carrollton, GA 30117
Phone (770) 838-8710

157 Clinic Ave
Ste 302A
Carrollton, GA 30117
Phone (770) 812-5886

705 Dixie St
Carrollton, GA 30117
Phone (770) 812-9666

690 Dallas Hwy
Ste 207A
Villa Rica, GA 30180
Phone (770) 456-3646

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1133740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418774400000",
    "number": "1255315016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 AMBULANCE DR.",
            "address_2": "SUITE 202",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173856",
            "telephone_number": "770-838-8787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 DIXIE ST",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174417",
            "telephone_number": "770-812-5831",
            "fax_number": "770-812-5832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAGUSZEWSKI",
        "first_name": "ROBERT",
        "middle_name": "K",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-05",
        "last_updated": "2014-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "GA",
            "license": "032792",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0004296684",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00429668C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrollton, GA

Sources for this page

Verify at the official NPI Registry.