Provider Demographics
NPI:1154348241
Name:NEALIS NEUROLOGY
Entity type:Organization
Organization Name:NEALIS NEUROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:NEALIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-725-5222
Mailing Address - Street 1:PO BOX 17809
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-7809
Mailing Address - Country:US
Mailing Address - Phone:904-723-0015
Mailing Address - Fax:904-338-0951
Practice Address - Street 1:7300 BEACH BLVD
Practice Address - Street 2:STE A
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-2946
Practice Address - Country:US
Practice Address - Phone:904-725-5222
Practice Address - Fax:904-725-0038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME31867174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDE9297OtherRAILROAD MEDICARE
FL15440OtherBCBS
FL293021OtherAVMED
FLQ0171OtherMEDICARE PTAN
FL278856OtherWELLCARE
FLQ0171OtherMEDICARE PTAN