Healthcare Provider Details

I. General information

NPI: 1699279455
Provider Name (Legal Business Name): NEUROLOGICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 TRACY WAY
CHARLESTON WV
25311-1257
US

IV. Provider business mailing address

100 TRACY WAY
CHARLESTON WV
25311-1257
US

V. Phone/Fax

Practice location:
  • Phone: 304-343-4583
  • Fax: 304-343-9207
Mailing address:
  • Phone: 304-343-4583
  • Fax: 304-343-9207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateWV

VIII. Authorized Official

Name: DIANA K WILLIAMSON
Title or Position: PRACTICE ADMINISTRATOR
Credential: CPA
Phone: 304-344-3551