Organization
NEUROWAVE DIAGNOSTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FANNIE CLARK (CEO)
(770) 557-0885
Entity
Organization
Contact information
Practice address
2227 IDLEWOOD RD, SUITE 400, TUCKER, GA 30084-4827
(770) 557-0885
(770) 557-0315
Mailing address
PO BOX 930905, NORCROSS, GA 30003-0905
(770) 557-0885
(770) 557-0315
Taxonomy
Speciality
Code
Description
License number
State
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
Primary
—
—
Other
Enumeration date
02/22/2010
Last updated
02/22/2010
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