Organization
MIDLANDS NEUROLOGY & PAIN ASSOC, P.A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
E OGBURU-OGBONNAYA MD MD (PRESIDENT CEO)
(803) 788-0038
Entity
Organization
Contact information
Practice address
2601 MILLWOOD AVE, MIDLANDS NEUROLOGY & PAIN ASSOC, P.A, COLUMBIA, SC 29205-1218
(803) 788-0038
(803) 788-0655
Mailing address
PO BOX 209, MIDLANDS NEUROLOGY & PAIN ASSOC, P.A, STATE PARK, SC 29147-0209
(803) 788-0038
(803) 788-0655
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
18323
SC
208VP0014X
Interventional Pain Medicine Physician
Primary
18323
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP1403
—
SC
Enumeration date
08/01/2006
Last updated
11/07/2016
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