Provider Demographics
NPI:1508926635
Name:CRANIOSPINAL INSTITUTE OF GEORGIA
Entity Type:Organization
Organization Name:CRANIOSPINAL INSTITUTE OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-424-2025
Mailing Address - Street 1:3901 ROSWELL RD STE 225
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8816
Mailing Address - Country:US
Mailing Address - Phone:770-424-2025
Mailing Address - Fax:770-425-1789
Practice Address - Street 1:3901 ROSWELL RD STE 225
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-8816
Practice Address - Country:US
Practice Address - Phone:770-424-2025
Practice Address - Fax:770-425-1789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5516980001Medicare NSC
GAGRP7337Medicare PIN