Provider Demographics
NPI:1740901610
Name:SOUTHERN TELENEUROLOGY SPECIALISTS
Entity type:Organization
Organization Name:SOUTHERN TELENEUROLOGY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ARYAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-609-9914
Mailing Address - Street 1:312 CANTON STONE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2691
Mailing Address - Country:US
Mailing Address - Phone:615-609-9914
Mailing Address - Fax:
Practice Address - Street 1:312 CANTON STONE DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2691
Practice Address - Country:US
Practice Address - Phone:615-609-9914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty