Healthcare Provider Details

I. General information

NPI: 1871054569
Provider Name (Legal Business Name): BRANDON CHASE NEELEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4607 MACCORKLE AVE SW STE 400
SOUTH CHARLESTON WV
25309-1364
US

IV. Provider business mailing address

4607 MACCORKLE AVE SW STE 400
SOUTH CHARLESTON WV
25309-1364
US

V. Phone/Fax

Practice location:
  • Phone: 304-767-7900
  • Fax: 304-414-7437
Mailing address:
  • Phone: 304-767-7900
  • Fax: 304-414-7437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number67945
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35488
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: