Provider Demographics
NPI:1831264597
Name:CLINIC FOR NEUROLOGY, PA
Entity type:Organization
Organization Name:CLINIC FOR NEUROLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BROOKS
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-533-4402
Mailing Address - Street 1:185 CHATEAU DR SW STE 301
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-7413
Mailing Address - Country:US
Mailing Address - Phone:256-533-4402
Mailing Address - Fax:256-551-1902
Practice Address - Street 1:185 CHATEAU DR SW STE 301
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-7413
Practice Address - Country:US
Practice Address - Phone:256-533-4402
Practice Address - Fax:256-551-1902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528301710Medicaid
ALC74488Medicare UPIN