Healthcare Provider Details
I. General information
NPI: 1679983241
Provider Name (Legal Business Name): COMPREHENSIVE NEUROLOGY CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/05/2014
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
5073 MAIN ST SUITE 200
SPRING HILL TN
37174-2737
US
IV. Provider business mailing address
2548 RIDEOUT LN
MURFREESBORO TN
37128-7686
US
V. Phone/Fax
- Phone: 615-410-4990
- Fax:
- Phone: 615-410-4990
- Fax: 615-410-4250
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084N0400X |
| Taxonomy | Neurology Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P2900X |
| Taxonomy | Pain Medicine (Psychiatry & Neurology) Physician |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208VP0000X |
| Taxonomy | Pain Medicine Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: MRS.
JULIE
SCHNEIDER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 608-217-9776