Provider Demographics
NPI:1518142280
Name:THE NEIL GROUP, INC
Entity Type:Organization
Organization Name:THE NEIL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANSFORD
Authorized Official - Middle Name:AUTHURBURY
Authorized Official - Last Name:NEIL
Authorized Official - Suffix:II
Authorized Official - Credentials:MA LPC
Authorized Official - Phone:336-774-2194
Mailing Address - Street 1:1400 MILLGATE DR STE D
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1338
Mailing Address - Country:US
Mailing Address - Phone:336-774-2194
Mailing Address - Fax:336-774-2195
Practice Address - Street 1:1399 ASHLEYBROOK LN STE 100
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2961
Practice Address - Country:US
Practice Address - Phone:336-774-2194
Practice Address - Fax:336-774-2195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01450207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907831Medicaid