Provider Demographics
NPI:1376649285
Name:HAMBLEN NEUROSCIENCE CENTER, P.C.
Entity Type:Organization
Organization Name:HAMBLEN NEUROSCIENCE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDELRAHMAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-587-7144
Mailing Address - Street 1:1907 W MORRIS BLVD
Mailing Address - Street 2:SUITE A 400
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-3860
Mailing Address - Country:US
Mailing Address - Phone:423-587-7144
Mailing Address - Fax:423-587-7145
Practice Address - Street 1:1907 W MORRIS BLVD
Practice Address - Street 2:SUITE A 400
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-3860
Practice Address - Country:US
Practice Address - Phone:423-587-7144
Practice Address - Fax:423-587-7145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD31933174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3731347Medicaid
TNH16107Medicare UPIN
TN3731347Medicare PIN