Provider Demographics
NPI:1215204128
Name:MINIMALLY INVASIVE NEUROSPINE AND PAIN INSTITUTE, P.C.
Entity Type:Organization
Organization Name:MINIMALLY INVASIVE NEUROSPINE AND PAIN INSTITUTE, P.C.
Other - Org Name:ALLSPINE SURGERY CENTER, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:REZAIAMIRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-997-0600
Mailing Address - Street 1:33 UPPER RIVERDALE RD SW
Mailing Address - Street 2:#25
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2626
Mailing Address - Country:US
Mailing Address - Phone:770-997-0600
Mailing Address - Fax:770-991-5576
Practice Address - Street 1:900 EAGLES LANDING PKWY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7343
Practice Address - Country:US
Practice Address - Phone:770-997-0600
Practice Address - Fax:770-991-5576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-20
Last Update Date:2011-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical