Southern Crescent Neurological Clinic,pc
Neurology Clinic
1250 Highway 54 W, 102, Fayetteville
Georgia, 30214-4545
770-719-2965 770-719-2963
Maps & DirectionsSouthern Crescent Neurological Clinic,pc is a Neurology Clinic in Fayetteville, Georgia. It is located at 1250 Highway 54 W, 102, Fayetteville, GA and its contact number is 770-719-2965. The authorized person for Southern Crescent Neurological Clinic,pc is Dr. Kenneth Jay Lazarus
who is Ceo of the clinic and his/her contact number is 770-719-2965. The primary license number for Southern Crescent Neurological Clinic,pc is 031058 (Neurology) in Georgia.
Southern Crescent Neurological Clinic,pc Clinic specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures.
Complete Clinic Profile:
Southern Crescent Neurological Clinic,pc Clinic speciality, address, contact phone number and fax are as below.
Patients can call on the below given phone number for appointments.
| Name: | Southern Crescent Neurological Clinic,pc |
| Specialization: | Neurology |
| Clinic Address: | 1250 Highway 54 W, 102, Fayetteville,
Georgia, 30214-4545 |
| Phone: | 770-719-2965 |
| Fax: | 770-719-2963 |
Authorized/Official Person Profile:
Officially authorized person to contact for any management issues or complaints for this clinic are as below. Person's position and contact details are also mentioned below.
| Name: | Dr. Kenneth Jay Lazarus |
| Position: | Ceo |
| Contact Number: | 770-719-2965 |
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details for Southern Crescent Neurological Clinic,pc clinic are as mentioned below.
| NPI Number: | 1013052182 |
| NPI Enumeration Date: | 20 Feb, 2007 |
| NPI Last Update On: | 21 Jun, 2018 |
Medical Licenses:
Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Southern Crescent Neurological Clinic,pc are as mentioned below.
| Specialization | License Number | State | Status | |
| Neurology | 031058 | Georgia | Primary | |
Other Medical Identifiers:
Other legacy medical identifiers of the clinic such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
| Identifier | Type | State | Issuer |
| 000406795D | Medicaid | Georgia | |
| GRP2807 | Other | Georgia | Medicare Facility Id |
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
| Address: | Southern Crescent Neurological Clinic,pc
1250 Highway 54 W, 102
Fayetteville, Georgia |
| Zip: | 30214-4545 |
| Phone Number: | 770-719-2965 |
| Fax Number: | 770-719-2963 |
Patients can reach Southern Crescent Neurological Clinic,pc at
1250 Highway 54 W, 102, Fayetteville, Georgia or can
call to book an appointment on 770-719-2965.
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Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 08 December, 2025.