Healthcare Provider Details

I. General information

NPI: 1902133671
Provider Name (Legal Business Name): MIDWEST NEUROPHYSIOLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5123 TINSON COURT
SUMMERVILLE SC
29485
US

IV. Provider business mailing address

PO BOX 6766
ATHENS GA
30604-6766
US

V. Phone/Fax

Practice location:
  • Phone: 706-951-0859
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: PRASHANT PATEL
Title or Position: MANAGING PARTNER
Credential:
Phone: 706-951-0859