Provider Demographics
NPI:1093581399
Name:LIVINGSPRING NEUROLOGY CENTER LLC
Entity Type:Organization
Organization Name:LIVINGSPRING NEUROLOGY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:OLUBUSOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-598-2123
Mailing Address - Street 1:109 HARRIGAN WAY
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-5609
Mailing Address - Country:US
Mailing Address - Phone:757-598-2123
Mailing Address - Fax:
Practice Address - Street 1:109 HARRIGAN WAY
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-5609
Practice Address - Country:US
Practice Address - Phone:757-598-2123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty