Provider Demographics
NPI:1033632419
Name:LEGACY BRAIN & SPINE LLC
Entity Type:Organization
Organization Name:LEGACY BRAIN & SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROSURGEON / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAID
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSHIHABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-291-8987
Mailing Address - Street 1:1900 THE EXCHANGE SE STE 200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2022
Mailing Address - Country:US
Mailing Address - Phone:770-291-8987
Mailing Address - Fax:770-291-8987
Practice Address - Street 1:718 CHEROKEE ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7253
Practice Address - Country:US
Practice Address - Phone:770-291-8987
Practice Address - Fax:770-291-8987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA60369207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI58731OtherMEDICARE