Provider Demographics
NPI:1346286853
Name:SENTINEL NEUROLOGICAL SERVICES
Entity Type:Organization
Organization Name:SENTINEL NEUROLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LATAI
Authorized Official - Middle Name:EBRETTE
Authorized Official - Last Name:GRANT BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-454-0152
Mailing Address - Street 1:2693 UNION AVENUE EXT
Mailing Address - Street 2:#204
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-4403
Mailing Address - Country:US
Mailing Address - Phone:901-454-0152
Mailing Address - Fax:901-454-0154
Practice Address - Street 1:2693 UNION AVENUE EXT
Practice Address - Street 2:#204
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-4403
Practice Address - Country:US
Practice Address - Phone:901-454-0152
Practice Address - Fax:901-454-0154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000393812084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3735105Medicare PIN