Provider Demographics
NPI:1629462759
Name:POLARIS CENTER FOR OUTPATIENT SPINE SURGERY
Entity Type:Organization
Organization Name:POLARIS CENTER FOR OUTPATIENT SPINE SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:J
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-256-2633
Mailing Address - Street 1:1150 HAMMOND DR.
Mailing Address - Street 2:BLDG E, SUITE 600
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328
Mailing Address - Country:US
Mailing Address - Phone:404-256-2633
Mailing Address - Fax:404-255-6532
Practice Address - Street 1:1150 HAMMOND DR.
Practice Address - Street 2:BLDG E, SUITE 600
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:404-256-2633
Practice Address - Fax:404-255-6532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QA1903X
261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical