NPIMap

Organization Active NPI

Neurodiagnostic Consultants, LLC

  • Neurology Physician
  • Marietta, GA
National Provider Identifier
1881928646
Registry record updated Jun 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
NEURODIAGNOSTIC CONSULTANTS, LLC
Practice address
2855 Julias Way NW
Marietta, GA 30064-6219
Phone
(770) 974-2200
Fax
(770) 974-2202
NPI assigned
Sep 28, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2024

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

Authorized official

Name
Debra SmothersNPI 1790140853
Title
Ceo
Phone
(844) 939-3811

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 Primary

Addresses

Primary practice location

2855 Julias Way NW
Marietta, GA 30064-6219

Mailing address

PO Box 986
Acworth, GA 30101-0986
Phone (844) 939-3811

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100201000400 GA Part B Supplier - Clinic/Group Practice 2668515586 Receives reassigned benefits from 3 practitioners
Practice locations: Marietta, GA; Macon, GA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

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": "1254096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718150400000",
    "number": "1881928646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 986",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301010986",
            "telephone_number": "844-939-3811",
            "fax_number": "678-647-7588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2855 JULIAS WAY NW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300646219",
            "telephone_number": "770-974-2200",
            "fax_number": "770-974-2202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEURODIAGNOSTIC CONSULTANTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-28",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A",
        "authorized_official_last_name": "SMOTHERS",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "844-939-3811"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; 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.