Provider Demographics
NPI:1366479727
Name:COMMONWEALTH NEURO SPECIALISTS PC
Entity Type:Organization
Organization Name:COMMONWEALTH NEURO SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-447-9033
Mailing Address - Street 1:PO BOX 654
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-0654
Mailing Address - Country:US
Mailing Address - Phone:434-447-9033
Mailing Address - Fax:434-447-9034
Practice Address - Street 1:501 LOMBARDY ST
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-2107
Practice Address - Country:US
Practice Address - Phone:434-447-9033
Practice Address - Fax:434-447-9034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010548172084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACJ6173OtherRAILROAD MEDICARE
VAC06957Medicare PIN