Provider Demographics
NPI:1407176647
Name:PHOEBE NEUROLOGY
Entity Type:Organization
Organization Name:PHOEBE NEUROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP PHYS PRACTICES
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGESSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-312-1000
Mailing Address - Street 1:2709 MEREDYTH DR
Mailing Address - Street 2:STE 230
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-0222
Mailing Address - Country:US
Mailing Address - Phone:229-312-5080
Mailing Address - Fax:229-312-5085
Practice Address - Street 1:2709 MEREDYTH DR
Practice Address - Street 2:STE 230
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-0218
Practice Address - Country:US
Practice Address - Phone:229-312-5080
Practice Address - Fax:229-312-5085
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHOEBE PHYSICIAN GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0646102084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty