Provider Demographics
NPI:1235214990
Name:NORTH GEORGIA SPINE OFFICES INC
Entity Type:Organization
Organization Name:NORTH GEORGIA SPINE OFFICES INC
Other - Org Name:NORTH GEORGIA SPINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALONZO
Authorized Official - Middle Name:MEISENZAHL
Authorized Official - Last Name:BORJA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-541-2300
Mailing Address - Street 1:1950 BUFORD MILL DRIVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519
Mailing Address - Country:US
Mailing Address - Phone:678-541-2300
Mailing Address - Fax:678-541-2301
Practice Address - Street 1:1950 BUFORD MILL DRIVE
Practice Address - Street 2:SUITE E
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519
Practice Address - Country:US
Practice Address - Phone:678-541-2300
Practice Address - Fax:678-541-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U77798Medicare UPIN
GA35ZCFTFMedicare ID - Type Unspecified