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General NPI Number Information
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NPI Number | 1275714966
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Entity Type | Organization
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Legal Business Name | ASSOCIATED NEUROLOGISTS PC
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Dates
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Enumeration Date | 11/21/2007
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Last Update Date | 10/01/2012
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Provider Practice Location Address
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Address Line | 1401 JOHNSTON WILLIS DR THE ATRIUM SUITE 5300
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City | RICHMOND
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State | VA
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Zip | 23235-4730
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Country | US
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Telephone | 804-323-1145
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Fax | 804-272-1903
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Provider Business Mailing Address
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Address Line | 1401 JOHNSTON WILLIS DR THE ATRIUM SUITE 5300
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City | RICHMOND
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State | VA
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Zip | 23235-4730
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Country | US
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Telephone | 804-323-1145
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Fax | 804-272-1903
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN JOSEPH HENNESSEY IV
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Credential | M.D.
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Telephone | 804-323-1145
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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 | 0101031272
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License Number State | VA
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