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General NPI Number Information
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NPI Number | 1508393208
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Entity Type | Organization
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Legal Business Name | NEUROLOGY AND NEURODIAGNOSTIC LLC
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Dates
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Enumeration Date | 05/12/2017
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Last Update Date | 08/24/2017
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Provider Practice Location Address
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Address Line | 1497 FAIR RD
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City | STATESBORO
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State | GA
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Zip | 30458-0822
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Country | US
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Telephone | 912-486-1140
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1639
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City | STATESBORO
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State | GA
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Zip | 30459
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Country | US
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Telephone | 912-486-1140
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KASHYAP PATEL
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Credential | MD
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Telephone | 912-481-9945
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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 | 64438
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License Number State | GA
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