Provider Demographics
NPI:1821143298
Name:ORTHO-NEURO CENTER, INC.
Entity Type:Organization
Organization Name:ORTHO-NEURO CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOON
Authorized Official - Middle Name:WHEE
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-373-0400
Mailing Address - Street 1:1376 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1519
Mailing Address - Country:US
Mailing Address - Phone:404-373-0400
Mailing Address - Fax:
Practice Address - Street 1:1376 CHURCH ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1519
Practice Address - Country:US
Practice Address - Phone:404-373-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3002111NR0400X
GA031958171100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Not Answered171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Not Answered208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11627735OtherCAQH