Provider Demographics
NPI:1972171536
Name:1 LIFE NEUROLOGY CENTER
Entity Type:Organization
Organization Name:1 LIFE NEUROLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:JENKIE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:256-898-6190
Mailing Address - Street 1:1919 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-2845
Mailing Address - Country:US
Mailing Address - Phone:256-898-6190
Mailing Address - Fax:
Practice Address - Street 1:1919 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-2845
Practice Address - Country:US
Practice Address - Phone:256-898-6190
Practice Address - Fax:256-898-6191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-11
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty