Organization
COMMUNITY NEUROLOGICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILIP R KENNEDY MD (OWNER/PHYSICIAN)
(770) 622-2230
Entity
Organization
Contact information
Practice address
3400 MCCLURE BRIDGE RD, SUITE D401, DULUTH, GA 30096-6675
(770) 622-2230
(770) 622-9741
Mailing address
3400 MCCLURE BRIDGE RD, SUITE D401, DULUTH, GA 30096-6675
(770) 622-2230
(770) 622-9741
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
GA039708
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000772813A
—
GA
Enumeration date
08/17/2007
Last updated
01/23/2009
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