=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932135498
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STANLY NEUROLOGY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2006
-----------------------------------------------------
Last Update Date | 06/08/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 923 N 2ND ST STE 102
-----------------------------------------------------
City | ALBEMARLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28001-3369
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-982-0122
-----------------------------------------------------
Fax | 704-982-0125
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 923 N 2ND ST STE 102
-----------------------------------------------------
City | ALBEMARLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28001-3369
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-982-0122
-----------------------------------------------------
Fax | 704-982-0125
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DAVID WILLIAM SCHMIDT
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 704-982-0122
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 99-00131
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------