Provider Demographics
NPI:1790101392
Name:RIVER CITY NEUROLOGICAL ASSOCIATES
Entity Type:Organization
Organization Name:RIVER CITY NEUROLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:Y
Authorized Official - Last Name:PATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-221-8799
Mailing Address - Street 1:2101 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-8806
Mailing Address - Country:US
Mailing Address - Phone:706-221-8799
Mailing Address - Fax:706-221-8979
Practice Address - Street 1:2101 NORTH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8806
Practice Address - Country:US
Practice Address - Phone:706-221-8799
Practice Address - Fax:706-221-8979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-07
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA71152207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty