Provider Demographics
NPI:1922542513
Name:DISC & SPINE CENTER CAROL A SAMUELS PC
Entity Type:Organization
Organization Name:DISC & SPINE CENTER CAROL A SAMUELS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-788-4285
Mailing Address - Street 1:4840 ROSWELL RD
Mailing Address - Street 2:SUITE C-100
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2639
Mailing Address - Country:US
Mailing Address - Phone:404-843-3040
Mailing Address - Fax:404-843-0119
Practice Address - Street 1:4840 ROSWELL RD
Practice Address - Street 2:SUITE C-100
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30342-2639
Practice Address - Country:US
Practice Address - Phone:404-843-3040
Practice Address - Fax:404-843-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2331111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU19578Medicare UPIN
GA142384307AMedicare PIN