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General NPI Number Information
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NPI Number | 1164589065
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Entity Type | Organization
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Legal Business Name | GOLDEN ISLES NEUROLOGY, PC
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 04/22/2011
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Provider Practice Location Address
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Address Line | 3226-C HAMPTON AVENUE
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City | BRUNSWICK
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State | GA
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Zip | 31520-4254
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Country | US
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Telephone | 912-261-0044
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Fax | 912-261-0226
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Provider Business Mailing Address
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Address Line | 3226-C HAMPTON AVENUE
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City | BRUNSWICK
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State | GA
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Zip | 31520-4254
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Country | US
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Telephone | 912-261-0044
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Fax | 912-261-0226
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ENRIQUE J FERNANDEZ
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Credential | MD
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Telephone | 912-261-0044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 036152
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | #036152
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License Number State | GA
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