Provider Demographics
NPI:1508185265
Name:PREMIER NEUROSURGICAL INSTITUTE, LLC
Entity Type:Organization
Organization Name:PREMIER NEUROSURGICAL INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:E
Authorized Official - Last Name:SPELLMAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:678-872-8755
Mailing Address - Street 1:PO BOX 4370
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30061-4370
Mailing Address - Country:US
Mailing Address - Phone:678-872-8755
Mailing Address - Fax:
Practice Address - Street 1:211 CHICOPEE DR NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1269
Practice Address - Country:US
Practice Address - Phone:678-872-8750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-20
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023819174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty