Provider Demographics
NPI:1164510160
Name:LAWRENCEBURG NEUROLOGY, PC
Entity Type:Organization
Organization Name:LAWRENCEBURG NEUROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMIRNOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-766-3139
Mailing Address - Street 1:PO BOX 753
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-0753
Mailing Address - Country:US
Mailing Address - Phone:931-766-3139
Mailing Address - Fax:931-766-3511
Practice Address - Street 1:190 PROSSER RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4233
Practice Address - Country:US
Practice Address - Phone:931-766-3139
Practice Address - Fax:931-766-3511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN361262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH58686Medicare UPIN