| Georgia Neurosciences Llc | |
|
1260 Highway 54 W Ste 200 Fayetteville GA 30214-4513 | |
| (214) 619-1910 | |
| (214) 619-1914 |
| Full Name | Georgia Neurosciences Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1260 Highway 54 W Ste 200, Fayetteville, Georgia |
| Authorized Official Name and Position | Nilay Sheth (PRACTICE MANAGER) |
| Authorized Official Contact | 4697743375 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Georgia Neurosciences Llc 1260 Highway 54 W Ste 200 Fayetteville GA 30214-4513 Ph: (214) 497-5046 | Georgia Neurosciences Llc 1260 Highway 54 W Ste 200 Fayetteville GA 30214-4513 Ph: (214) 619-1910 |
| NPI Number | 1649871351 |
|---|---|
| Provider Enumeration Date | 11/09/2020 |
| Last Update Date | 03/11/2025 |
| Certification Date | 03/11/2025 |
| Medicare PECOS PAC ID | 1052840352 |
|---|---|
| Medicare Enrollment ID | O20250131001581 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649871351 | NPI | - | NPPES |
| 1245271402 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Lisa Avery |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1699008409 PECOS PAC ID: 5698996585 Enrollment ID: I20250212000424 |
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