Organization
NORTHGATE NEUROLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CORNELIUS J. MANCE M.D. (PRESIDENT)
(423) 877-1212
Entity
Organization
Contact information
Practice address
2051 HAMILL RD, SUITE 301B, HIXSON, TN 37343-4026
(423) 877-1212
(423) 877-6793
Mailing address
PO BOX 28107, CHATTANOOGA, TN 37424-8107
(423) 877-1212
(423) 877-6793
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD 19747
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
166110100
DEPARTMENT OF LABOR
TN
Enumeration date
04/17/2007
Last updated
09/02/2020
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