Southern Crescent Neurological Clinic,pc
NPI #1013052182 in Fayetteville, Georgia
Provider Information
- NPI Number
- 1013052182
- Entity Type
- Organization
- Organization Name
- Southern Crescent Neurological Clinic,pc
- Primary Specialty
- Psychiatry & Neurology - Neurology
- Enumeration Date
- Feb 20, 2007
- Last Updated
- Jun 21, 2018
Practice Location
- Address
- 1250 HIGHWAY 54 W
- Address 2
- 102
- City
- Fayetteville
- State
- Georgia
- ZIP Code
- 30214-4545
- Phone
- (770) 719-2965
Authorized Official
- Name
- DR. KENNETH JAY LAZARUS, M.D. ,P.H.D.
- Title
- CEO
- Phone
- (770) 719-2965
Specialties & Taxonomy Codes
| Specialty |
|---|
| Psychiatry & Neurology - Neurology — Neurology |
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