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General NPI Number Information
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NPI Number | 1679902860
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Entity Type | Organization
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Legal Business Name | THE NEUROLOGY CENTER PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 11/07/2013
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Last Update Date | 06/03/2018
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Provider Practice Location Address
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Address Line | 415 CARRIAGE DR
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City | BECKLEY
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State | WV
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Zip | 25801
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Country | US
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Telephone | 304-894-8975
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Fax | 304-894-8976
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Provider Business Mailing Address
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Address Line | PO BOX 1658
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City | BEAVER
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State | WV
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Zip | 25813-1658
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Country | US
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Telephone | 304-894-8975
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Fax | 888-878-6934
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MS. GEORGIANNA RICHARDS
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Credential | MD
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Telephone | 304-894-8975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 24287
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License Number State | WV
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