Provider Demographics
NPI:1912233701
Name:CLINICAL NEUROLOGY & ELECTRODIAGNOSTICS, P.A.
Entity Type:Organization
Organization Name:CLINICAL NEUROLOGY & ELECTRODIAGNOSTICS, P.A.
Other - Org Name:CNEDX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-850-6831
Mailing Address - Street 1:PO BOX 982
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39158-0982
Mailing Address - Country:US
Mailing Address - Phone:601-850-6831
Mailing Address - Fax:601-850-6831
Practice Address - Street 1:135 BRIDGEWATER XING
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-8602
Practice Address - Country:US
Practice Address - Phone:601-850-6831
Practice Address - Fax:601-850-6831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08376542Medicaid
MS08376542Medicaid