Provider Demographics
NPI:1023335270
Name:NORTHWEST NEUROLOGICAL ASSOCIATES PLLC
Entity type:Organization
Organization Name:NORTHWEST NEUROLOGICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAQBOOL
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-245-6020
Mailing Address - Street 1:298 CLEAR SKY CT
Mailing Address - Street 2:SUITE F
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5685
Mailing Address - Country:US
Mailing Address - Phone:931-245-6020
Mailing Address - Fax:931-245-0624
Practice Address - Street 1:298 CLEAR SKY CT
Practice Address - Street 2:SUITE F
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5685
Practice Address - Country:US
Practice Address - Phone:931-245-6020
Practice Address - Fax:931-245-0624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103G135569Medicare PIN