Provider Demographics
NPI:1063897668
Name:NEUROLOGY CENTER PLLC
Entity type:Organization
Organization Name:NEUROLOGY CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:ANSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-905-4144
Mailing Address - Street 1:2000 QUEENS BLUFF WAY
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4858
Mailing Address - Country:US
Mailing Address - Phone:931-905-4144
Mailing Address - Fax:931-905-4143
Practice Address - Street 1:1750 MEMORIAL DR
Practice Address - Street 2:SUITE C
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-6356
Practice Address - Country:US
Practice Address - Phone:931-905-4144
Practice Address - Fax:931-905-4143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41086204R00000X, 2084S0012X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Multi-Specialty
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty