Healthcare Provider Details

I. General information

NPI: 1033154786
Provider Name (Legal Business Name): SKYLINE NEUROSCIENCE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3443 DICKERSON PIKE STE 580
NASHVILLE TN
37207-2526
US

IV. Provider business mailing address

2000 HEALTH PARK DR
BRENTWOOD TN
37027-4525
US

V. Phone/Fax

Practice location:
  • Phone: 615-860-1351
  • Fax: 615-860-1242
Mailing address:
  • Phone: 615-860-1351
  • Fax: 866-831-4898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036143179
License Number StateIL

VIII. Authorized Official

Name: LOUIS R JOSEPH III
Title or Position: VICE PRESIDENT
Credential:
Phone: 615-373-7630