=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821563107
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPREHENSIVE NEUROLOGY CENTER, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2018
-----------------------------------------------------
Last Update Date | 10/12/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 BERRYWOOD DR
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38401-6409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-410-4990
-----------------------------------------------------
Fax | 615-410-4250
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2548 RIDEOUT LN
-----------------------------------------------------
City | MURFREESBORO
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37128-7686
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-663-9405
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | RONA HATTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-410-4990
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208VP0000X
-----------------------------------------------------
Taxonomy Name | Pain Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------