Provider Demographics
NPI:1164589065
Name:GOLDEN ISLES NEUROLOGY, PC
Entity Type:Organization
Organization Name:GOLDEN ISLES NEUROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:J
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-261-0044
Mailing Address - Street 1:3226-C HAMPTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4254
Mailing Address - Country:US
Mailing Address - Phone:912-261-0044
Mailing Address - Fax:912-261-0226
Practice Address - Street 1:3226-C HAMPTON AVENUE
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4254
Practice Address - Country:US
Practice Address - Phone:912-261-0044
Practice Address - Fax:912-261-0226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036152174400000X
GA#036152174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA#000518647JMedicaid
GA000518647JMedicaid
GADC3356OtherRAILROAD MEDICARE
GAGRP6883Medicare PIN
GADC3356OtherRAILROAD MEDICARE
#GRP6883Medicare PIN