=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396857678
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHOALS NEUROLOGY CLINIC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 122 HELTON CT
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35630-1465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-718-0099
-----------------------------------------------------
Fax | 256-718-0006
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 122 HELTON CT
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-718-0099
-----------------------------------------------------
Fax | 256-718-0006
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SIRIPIREDDY R REDDY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 256-718-0099
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 9618
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------