Provider Demographics
NPI:1497226682
Name:LIFESTYLE NEUROLOGY PC
Entity Type:Organization
Organization Name:LIFESTYLE NEUROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:888-325-1691
Mailing Address - Street 1:8777 JOHANNESBURG DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139-6503
Mailing Address - Country:US
Mailing Address - Phone:888-325-1691
Mailing Address - Fax:888-325-1692
Practice Address - Street 1:2215 WEST ST STE 100
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3874
Practice Address - Country:US
Practice Address - Phone:901-440-8482
Practice Address - Fax:901-440-8582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2019-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty