Provider Demographics
NPI:1659524114
Name:TENNESSEE NEUROLOGY PLLC
Entity Type:Organization
Organization Name:TENNESSEE NEUROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:EDGEWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-768-4300
Mailing Address - Street 1:300 STONECREST BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-5688
Mailing Address - Country:US
Mailing Address - Phone:615-768-4300
Mailing Address - Fax:615-768-4400
Practice Address - Street 1:300 STONECREST BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-5688
Practice Address - Country:US
Practice Address - Phone:615-768-4300
Practice Address - Fax:615-768-4400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39356174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNI30187Medicare UPIN