MEDICARE: GREENVILLE NEUROLOGY CONSULTANTS, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	17836	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073618732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENVILLE NEUROLOGY CONSULTANTS, PA

Provider Business Mailing Address
First Line	:	4 OLD GROVE RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29605-4712
Country	:	US
Telephone Number	:	864-242-9662
Fax Number	:	864-467-0980

Provider Business Practice Location Address
First Line	:	4 OLD GROVE RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29605-4712
Country	:	US
Telephone Number	:	864-242-9662
Fax Number	:	864-467-0980

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. GENNA MARIE LYNN
Credential	:	CMOM
Telephone Number	:	864-242-9662

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	03/23/2010

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