Provider Demographics
NPI:1871841171
Name:ANDALUSIA NEUROLOGY PC
Entity Type:Organization
Organization Name:ANDALUSIA NEUROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SADIK
Authorized Official - Middle Name:
Authorized Official - Last Name:YESIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-222-3222
Mailing Address - Street 1:109 MEDICAL PARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-5323
Mailing Address - Country:US
Mailing Address - Phone:334-222-3222
Mailing Address - Fax:334-222-3224
Practice Address - Street 1:109 MEDICAL PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-5323
Practice Address - Country:US
Practice Address - Phone:334-222-3222
Practice Address - Fax:334-222-3224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL317862084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPENDINGMedicaid
ALPENDINGMedicare PIN
ALG68187Medicare UPIN