Provider Demographics
NPI:1033475140
Name:SOUTH DEKALB SPINAL CENTER, LLC
Entity Type:Organization
Organization Name:SOUTH DEKALB SPINAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-284-5556
Mailing Address - Street 1:4480 COVINGTON HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-1218
Mailing Address - Country:US
Mailing Address - Phone:404-284-5556
Mailing Address - Fax:404-284-5557
Practice Address - Street 1:4480 COVINGTON HWY
Practice Address - Street 2:SUITE A
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-1218
Practice Address - Country:US
Practice Address - Phone:404-284-5556
Practice Address - Fax:404-284-5557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain