Provider Demographics
NPI:1902281173
Name:LIFESTYLE NEUROLOGY, LLC
Entity Type:Organization
Organization Name:LIFESTYLE NEUROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-238-0471
Mailing Address - Street 1:420 THE PARKWAY
Mailing Address - Street 2:SUITE N
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-5205
Mailing Address - Country:US
Mailing Address - Phone:864-655-4005
Mailing Address - Fax:
Practice Address - Street 1:420 THE PARKWAY
Practice Address - Street 2:SUITE N
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-5205
Practice Address - Country:US
Practice Address - Phone:864-655-4005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC305852084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1538406491OtherNPI
1679057772OtherNPI