Provider Demographics
NPI:1407169212
Name:GEORGIA SPINE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:GEORGIA SPINE SURGERY CENTER, LLC
Other - Org Name:GNS SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT- BLUE CHIP OF ATHENS
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-561-8900
Mailing Address - Street 1:1061 DOWDY RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-5700
Mailing Address - Country:US
Mailing Address - Phone:706-543-9222
Mailing Address - Fax:706-543-9230
Practice Address - Street 1:1061 DOWDY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-5700
Practice Address - Country:US
Practice Address - Phone:513-561-8900
Practice Address - Fax:513-561-8901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical