Provider Demographics
NPI:1730224056
Name:WEST TENNESSEE NEUROLOGY, P. C.
Entity type:Organization
Organization Name:WEST TENNESSEE NEUROLOGY, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-681-9895
Mailing Address - Street 1:PO BOX 341638
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38184-1638
Mailing Address - Country:US
Mailing Address - Phone:901-213-4225
Mailing Address - Fax:901-213-4226
Practice Address - Street 1:6570 STAGE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2839
Practice Address - Country:US
Practice Address - Phone:901-213-4225
Practice Address - Fax:901-213-4226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3728239Medicare ID - Type Unspecified