Provider Demographics
NPI:1336583871
Name:SPORTS SPINE & REHAB SPECIALISTS LLC
Entity Type:Organization
Organization Name:SPORTS SPINE & REHAB SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ENE
Authorized Official - Middle Name:OJILE
Authorized Official - Last Name:SAINT-PREUX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-851-6418
Mailing Address - Street 1:115 CLARIN WAY
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3439
Mailing Address - Country:US
Mailing Address - Phone:404-965-0874
Mailing Address - Fax:
Practice Address - Street 1:3379 PEACHTREE RD NE # 0
Practice Address - Street 2:SUITE 555
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1031
Practice Address - Country:US
Practice Address - Phone:404-965-0874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-27
Last Update Date:2013-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA68551208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty