Provider Demographics
NPI:1609244524
Name:GEORGIA SPINE & ORTHOPEDICS LLC
Entity Type:Organization
Organization Name:GEORGIA SPINE & ORTHOPEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC SPINE SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:WINSTON
Authorized Official - Middle Name:R
Authorized Official - Last Name:JESHURAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-787-6255
Mailing Address - Street 1:PO BOX 26984
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31221-6984
Mailing Address - Country:US
Mailing Address - Phone:478-719-8895
Mailing Address - Fax:
Practice Address - Street 1:310 HOSPITAL DR STE 210
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-8026
Practice Address - Country:US
Practice Address - Phone:478-787-6255
Practice Address - Fax:478-812-8700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA59432207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty