MEDICARE: SOUTHERN NEUROLOGY PC

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	207T00000X	Neurological Surgery Physician

General Provider Information

NPI Number	:	1679554620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN NEUROLOGY PC

Provider Business Mailing Address
First Line	:	2018 BROOKWOOD MEDICAL CTR DR
Second Line	:	SUITE 202
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-6898
Country	:	US
Telephone Number	:	205-879-4200
Fax Number	:	205-870-7372

Provider Business Practice Location Address
First Line	:	2018 BROOKWOOD MEDICAL CTR DR
Second Line	:	SUITE 202
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-6898
Country	:	US
Telephone Number	:	205-879-4200
Fax Number	:	205-870-7372

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GORDON J KIRSCHBERG
Credential	:	MD
Telephone Number	:	205-879-4200

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	08/22/2020

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