Provider Demographics
NPI:1437167137
Name:NEUROLOGICAL ASSSOCIATE OF AUGUSTA, PC
Entity Type:Organization
Organization Name:NEUROLOGICAL ASSSOCIATE OF AUGUSTA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:BASHINSKI
Authorized Official - Last Name:SHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-860-6515
Mailing Address - Street 1:1210 ROY ROAD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909
Mailing Address - Country:US
Mailing Address - Phone:706-860-6515
Mailing Address - Fax:706-396-0055
Practice Address - Street 1:1210 ROY RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1812
Practice Address - Country:US
Practice Address - Phone:706-860-6515
Practice Address - Fax:706-396-0055
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEUROLOGICAL ASSOCIATES OF AUGUSTA, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-04
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207T00000X, 2084N0400X, 208VP0014X
GA0248952084N0400X
GA0352692084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3753Medicare ID - Type Unspecified