Provider Demographics
NPI:1720145964
Name:BRENTWOOD NEUROLOGY
Entity Type:Organization
Organization Name:BRENTWOOD NEUROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-661-6365
Mailing Address - Street 1:343 FRANKLIN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5250
Mailing Address - Country:US
Mailing Address - Phone:615-661-6365
Mailing Address - Fax:615-661-5981
Practice Address - Street 1:343 FRANKLIN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5213
Practice Address - Country:US
Practice Address - Phone:615-661-6365
Practice Address - Fax:615-661-5981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD140872084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3848423Medicare PIN
TNB04751Medicare UPIN