MEDICARE: NEUROSOMATIC INSTITUTE OF COLUMBUS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician

General Provider Information

NPI Number	:	1245186956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROSOMATIC INSTITUTE OF COLUMBUS LLC

Provider Business Mailing Address
First Line	:	1629 10TH AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-3518
Country	:	US
Telephone Number	:	706-408-7751
Fax Number	:

Provider Business Practice Location Address
First Line	:	1629 10TH AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-3518
Country	:	US
Telephone Number	:	706-464-7074
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	REINALDO VERSON
Credential	:	MD
Telephone Number	:	706-408-7751

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	06/17/2026

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