Provider Demographics
NPI:1245689777
Name:SPORTS AND SPINE INSTITUTE
Entity type:Organization
Organization Name:SPORTS AND SPINE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMRISH
Authorized Official - Middle Name:DINUBHAI
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-580-3607
Mailing Address - Street 1:2340 PATRICK HENRY PKWY
Mailing Address - Street 2:150
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-4325
Mailing Address - Country:US
Mailing Address - Phone:678-866-3646
Mailing Address - Fax:678-804-6862
Practice Address - Street 1:2340 PATRICK HENRY PKWY
Practice Address - Street 2:150
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-4325
Practice Address - Country:US
Practice Address - Phone:678-866-3646
Practice Address - Fax:678-804-6862
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTA SPORTS AND SPINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0679502081S0010X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty