Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Southern Crescent Neurological Clinic, PC

Organization Neurology Physician · NPI 1013052182

Southern Crescent Neurological Clinic, PC is a Neurology Physician in Fayetteville, Georgia. Licensed in Georgia. Registered with an NPI since 2007.

Licensed in
GA
In the registry since
2007
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1250 Highway 54 W 102
Fayetteville, GA 30214-4545
Phone: (770) 719-2965
Fax: (770) 719-2963
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Neurology Physician (primary) Taxonomy 2084N0400X · Licence 031058 (GA)

Record details

NPI number1013052182
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kenneth Lazarus — Ceo · (770) 719-2965
NPI enumeratedFebruary 20, 2007
Last updated in NPPESJune 21, 2018
Mailing address1250 Highway 54 W, 102, Fayetteville, GA 30214-4545

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