Healthcare Provider Details

I. General information

NPI: 1932409224
Provider Name (Legal Business Name): LAGRANGE NEUROLOGY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MEDICAL DR SUITE 701
LAGRANGE GA
30240-4130
US

IV. Provider business mailing address

300 MEDICAL DR SUITE 701
LAGRANGE GA
30240-4130
US

V. Phone/Fax

Practice location:
  • Phone: 706-882-0552
  • Fax: 706-882-0599
Mailing address:
  • Phone: 706-882-0552
  • Fax: 706-882-0599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MS. PAIGE BASS HUNT
Title or Position: OFFICE MANAGER
Credential:
Phone: 706-882-0552