Provider Demographics
NPI:1932409224
Name:LAGRANGE NEUROLOGY CORPORATION
Entity Type:Organization
Organization Name:LAGRANGE NEUROLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BASS HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-882-0552
Mailing Address - Street 1:300 MEDICAL DR
Mailing Address - Street 2:SUITE 701
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4130
Mailing Address - Country:US
Mailing Address - Phone:706-882-0552
Mailing Address - Fax:706-882-0599
Practice Address - Street 1:300 MEDICAL DR
Practice Address - Street 2:SUITE 701
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4130
Practice Address - Country:US
Practice Address - Phone:706-882-0552
Practice Address - Fax:706-882-0599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty