Provider Demographics
NPI:1326130097
Name:GARLAND NEUROLOGICAL CLINIC PA
Entity Type:Organization
Organization Name:GARLAND NEUROLOGICAL CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHMOOD
Authorized Official - Middle Name:S
Authorized Official - Last Name:AKHAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-494-1100
Mailing Address - Street 1:315 N SHILOH RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-6682
Mailing Address - Country:US
Mailing Address - Phone:972-494-1100
Mailing Address - Fax:972-494-4909
Practice Address - Street 1:315 N SHILOH RD
Practice Address - Street 2:SUITE 103
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-6682
Practice Address - Country:US
Practice Address - Phone:972-494-1100
Practice Address - Fax:972-494-4909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172861001Medicaid
TX00482XMedicare ID - Type Unspecified