Provider Demographics
NPI:1710198809
Name:SPINE CENTERS OF GEORGIA, LLC
Entity Type:Organization
Organization Name:SPINE CENTERS OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OFFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DANAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:866-592-9432
Mailing Address - Street 1:11877 DOUGLAS RD
Mailing Address - Street 2:SUITE 102-271
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4325
Mailing Address - Country:US
Mailing Address - Phone:866-592-9432
Mailing Address - Fax:866-689-0005
Practice Address - Street 1:11877 DOUGLAS RD
Practice Address - Street 2:SUITE 102-271
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4325
Practice Address - Country:US
Practice Address - Phone:866-592-9432
Practice Address - Fax:866-689-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036000208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty