Provider Demographics
NPI:1346461720
Name:NEUROLOGICAL SPECIALISTS PLLC
Entity Type:Organization
Organization Name:NEUROLOGICAL SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-756-1954
Mailing Address - Street 1:PO BOX 100234
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 COIT RD
Practice Address - Street 2:SUITE 306
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6174
Practice Address - Country:US
Practice Address - Phone:972-612-6888
Practice Address - Fax:972-612-6880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189211901Medicaid
DG0531Medicare PIN
TX00X954Medicare PIN