Provider Demographics
NPI:1437347044
Name:SATILLA SPINE CENTER
Entity Type:Organization
Organization Name:SATILLA SPINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEFAND
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:912-287-1414
Mailing Address - Street 1:228 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-3541
Mailing Address - Country:US
Mailing Address - Phone:912-287-1414
Mailing Address - Fax:912-287-1884
Practice Address - Street 1:228 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-3541
Practice Address - Country:US
Practice Address - Phone:912-287-1414
Practice Address - Fax:912-287-1884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4251OtherMEDICARE GROUP NUMBER
GADA4251OtherRAILROAD MEDICARE GROUP #