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General NPI Number Information
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NPI Number | 1073618732
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Entity Type | Organization
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Legal Business Name | GREENVILLE NEUROLOGY CONSULTANTS, PA
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 03/23/2010
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Provider Practice Location Address
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Address Line | 4 OLD GROVE RD
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City | GREENVILLE
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State | SC
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Zip | 29605-4712
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Country | US
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Telephone | 864-242-9662
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Fax | 864-467-0980
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Provider Business Mailing Address
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Address Line | 4 OLD GROVE RD
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City | GREENVILLE
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State | SC
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Zip | 29605-4712
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Country | US
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Telephone | 864-242-9662
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Fax | 864-467-0980
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. GENNA MARIE LYNN
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Credential | CMOM
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Telephone | 864-242-9662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 17836
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License Number State | SC
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