Healthcare Provider Details

I. General information

NPI: 1417165127
Provider Name (Legal Business Name): NEUROLOGY NEURODIAGNOSTIC LAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CAHABA VALLEY PKWY STE 100
PELHAM AL
35124-1187
US

IV. Provider business mailing address

3590B PELHAM PKWY STE B
PELHAM AL
35124-2034
US

V. Phone/Fax

Practice location:
  • Phone: 205-664-2967
  • Fax: 205-664-9689
Mailing address:
  • Phone: 205-664-2967
  • Fax: 205-664-9689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number9098
License Number StateAL

VIII. Authorized Official

Name: NASROLLAH ESLAMI
Title or Position: PROVIDER
Credential:
Phone: 205-664-2967