Provider Demographics
NPI:1801926381
Name:SUMNER NEUROLOGY ASSOCIATES, PLLC
Entity type:Organization
Organization Name:SUMNER NEUROLOGY ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAWAID
Authorized Official - Middle Name:
Authorized Official - Last Name:AHSAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-402-1053
Mailing Address - Street 1:PO BOX 680010
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-0001
Mailing Address - Country:US
Mailing Address - Phone:678-402-1053
Mailing Address - Fax:678-402-5619
Practice Address - Street 1:1000 JOHNSON FERRY RD BLDG F
Practice Address - Street 2:STE.120
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2114
Practice Address - Country:US
Practice Address - Phone:678-402-1053
Practice Address - Fax:678-402-5619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16896261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA871643718AMedicaid
TN871643718AMedicaid
GAFA1875624Medicaid
TN38882344Medicare PIN
H93365Medicare UPIN
GA871643718AMedicaid