Provider Demographics
NPI:1598894495
Name:SOUTHEASTERN NEUROLOGY, INC.
Entity Type:Organization
Organization Name:SOUTHEASTERN NEUROLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BEI
Authorized Official - Middle Name:H
Authorized Official - Last Name:TANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-671-0407
Mailing Address - Street 1:4850 FAYETTEVILLE RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2100
Mailing Address - Country:US
Mailing Address - Phone:910-671-0407
Mailing Address - Fax:910-671-0570
Practice Address - Street 1:4850 FAYETTEVILLE RD
Practice Address - Street 2:SUITE E
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2100
Practice Address - Country:US
Practice Address - Phone:910-671-0407
Practice Address - Fax:910-671-0570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty