Provider Demographics
NPI:1073057626
Name:SOUTH ATLANTA SPINE AND JOINT CENTER LLC
Entity Type:Organization
Organization Name:SOUTH ATLANTA SPINE AND JOINT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC, FACMUAP
Authorized Official - Phone:774-957-7738
Mailing Address - Street 1:541 FOREST PKWY
Mailing Address - Street 2:SUITE 14
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-6144
Mailing Address - Country:US
Mailing Address - Phone:404-431-9011
Mailing Address - Fax:877-292-4848
Practice Address - Street 1:541 FOREST PKWY STE 14
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-6110
Practice Address - Country:US
Practice Address - Phone:877-495-7773
Practice Address - Fax:877-292-4848
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHENIX CITY SPINE AND JOINT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-15
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR004974111N00000X
GACHIR009021111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACHIR004974OtherSTATE OF GEORGIA