Provider Demographics
NPI:1346680139
Name:ATLANTIC NEUROSURGICAL & SPINE SPECIALIST, P.A
Entity Type:Organization
Organization Name:ATLANTIC NEUROSURGICAL & SPINE SPECIALIST, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUFFMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-763-3333
Mailing Address - Street 1:2208 S 17TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7593
Mailing Address - Country:US
Mailing Address - Phone:910-763-3333
Mailing Address - Fax:910-763-3336
Practice Address - Street 1:215 STATION ST
Practice Address - Street 2:SUITE A-2
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6304
Practice Address - Country:US
Practice Address - Phone:910-763-3333
Practice Address - Fax:910-763-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty