Provider Demographics
NPI:1548267453
Name:HIGHLAND NEUROLOGY, INC
Entity type:Organization
Organization Name:HIGHLAND NEUROLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KOFI
Authorized Official - Middle Name:ADELEKE
Authorized Official - Last Name:DOONQUAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-347-7998
Mailing Address - Street 1:2509 RICHARDSON DR STE A
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-5926
Mailing Address - Country:US
Mailing Address - Phone:336-347-7998
Mailing Address - Fax:336-348-6745
Practice Address - Street 1:2509 RICHARDSON DR STE A
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-5926
Practice Address - Country:US
Practice Address - Phone:336-347-7998
Practice Address - Fax:336-348-6745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012263712084N0400X
NC2000007742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7117485OtherVA MEDICAID
NC89127VGMedicaid
NC2283766AMedicare ID - Type Unspecified
H16422Medicare UPIN
NC89127VGMedicaid