Provider Demographics
NPI:1679025878
Name:MIDSOUTH NEUROLOGY CLINIC PLLC
Entity Type:Organization
Organization Name:MIDSOUTH NEUROLOGY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MAROUN
Authorized Official - Middle Name:
Authorized Official - Last Name:DICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-233-3385
Mailing Address - Street 1:8577 CORDES CIR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139-3317
Mailing Address - Country:US
Mailing Address - Phone:901-233-3385
Mailing Address - Fax:
Practice Address - Street 1:8577 CORDES CIR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38139-3317
Practice Address - Country:US
Practice Address - Phone:901-233-3385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty