Provider Demographics
NPI:1821563107
Name:COMPREHENSIVE NEUROLOGY CENTER, PLLC
Entity type:Organization
Organization Name:COMPREHENSIVE NEUROLOGY CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RONA
Authorized Official - Middle Name:
Authorized Official - Last Name:HATTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-410-4990
Mailing Address - Street 1:2548 RIDEOUT LN
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-7686
Mailing Address - Country:US
Mailing Address - Phone:615-663-9405
Mailing Address - Fax:
Practice Address - Street 1:103 BERRYWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-6409
Practice Address - Country:US
Practice Address - Phone:615-410-4990
Practice Address - Fax:615-410-4250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1525675Medicaid