Provider Demographics
NPI:1215169131
Name:THE NEUROLOGY CENTER OF GADSDEN, LLC
Entity type:Organization
Organization Name:THE NEUROLOGY CENTER OF GADSDEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:JUST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-547-8988
Mailing Address - Street 1:502 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5217
Mailing Address - Country:US
Mailing Address - Phone:256-547-8988
Mailing Address - Fax:256-547-8986
Practice Address - Street 1:502 S 4TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5217
Practice Address - Country:US
Practice Address - Phone:256-547-8988
Practice Address - Fax:256-547-8986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19952261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALF27828Medicare UPIN