Provider Demographics
NPI:1558699462
Name:PREMIERE NEUROLOGY PC
Entity Type:Organization
Organization Name:PREMIERE NEUROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PREM
Authorized Official - Middle Name:S
Authorized Official - Last Name:PARIHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-953-5340
Mailing Address - Street 1:1558 WATSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3432
Mailing Address - Country:US
Mailing Address - Phone:478-922-6140
Mailing Address - Fax:478-922-6141
Practice Address - Street 1:1558 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3432
Practice Address - Country:US
Practice Address - Phone:478-922-6140
Practice Address - Fax:478-922-6141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-04
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0473552084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000855148BMedicaid
GAH06307Medicare UPIN
GA000855148BMedicaid