Provider Demographics
NPI:1467775734
Name:PALMYRA BRAIN & SPINE CENTER, LLC
Entity Type:Organization
Organization Name:PALMYRA BRAIN & SPINE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-5135
Mailing Address - Street 1:2002 PALMYRA RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1591
Mailing Address - Country:US
Mailing Address - Phone:229-420-1464
Mailing Address - Fax:229-420-1471
Practice Address - Street 1:2002 PALMYRA RD
Practice Address - Street 2:SUITE 202
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1591
Practice Address - Country:US
Practice Address - Phone:478-474-4343
Practice Address - Fax:229-420-1471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty