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General NPI Number Information
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NPI Number | 1093581399
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Entity Type | Organization
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Legal Business Name | LIVINGSPRING NEUROLOGY CENTER LLC
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Dates
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Enumeration Date | 11/28/2023
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 109 HARRIGAN WAY
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City | YORKTOWN
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State | VA
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Zip | 23693-5609
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Country | US
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Telephone | 757-598-2123
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Fax |
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Provider Business Mailing Address
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Address Line | 109 HARRIGAN WAY
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City | YORKTOWN
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State | VA
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Zip | 23693-5609
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Country | US
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Telephone | 757-598-2123
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | OLUBUSOLA AMIOLA
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Credential | MD
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Telephone | 757-598-2123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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