Provider Demographics
NPI:1134839988
Name:AXIS JOINT & SPINE SURGICAL CENETR
Entity type:Organization
Organization Name:AXIS JOINT & SPINE SURGICAL CENETR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FITZ
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-431-7386
Mailing Address - Street 1:1506 ROCK QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5047
Mailing Address - Country:US
Mailing Address - Phone:678-782-7999
Mailing Address - Fax:404-334-7274
Practice Address - Street 1:1001 VIRGINIA AVE STE 150
Practice Address - Street 2:
Practice Address - City:HAPEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30354-1373
Practice Address - Country:US
Practice Address - Phone:678-782-7999
Practice Address - Fax:404-334-7274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1962433508OtherCOMMERCIAL INSURANCE