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General NPI Number Information
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NPI Number | 1922030360
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Entity Type | Organization
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Legal Business Name | NEURO-EVAL, P.C.
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 105 N PONTIAC AVE SUITE 1
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City | DOTHAN
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State | AL
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Zip | 36303-3959
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Country | US
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Telephone | 334-677-6425
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Fax | 334-677-6921
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Provider Business Mailing Address
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Address Line | 105 N PONTIAC AVE SUITE 1
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City | DOTHAN
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State | AL
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Zip | 36303-3959
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Country | US
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Telephone | 334-677-6425
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Fax | 334-677-6921
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. BRENDA BENTON
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Credential |
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Telephone | 334-677-6425
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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 | 10583
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License Number State | AL
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