Provider Demographics
NPI:1356580476
Name:PREIMER NEUROSURGICAL INSTITUTE
Entity type:Organization
Organization Name:PREIMER NEUROSURGICAL INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:E
Authorized Official - Last Name:SPELLMAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:404-441-5987
Mailing Address - Street 1:4350 FREYS FARM LN NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7323
Mailing Address - Country:US
Mailing Address - Phone:404-441-5987
Mailing Address - Fax:
Practice Address - Street 1:4350 FREYS FARM LN NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7323
Practice Address - Country:US
Practice Address - Phone:404-441-5987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003649207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAB38170Medicare UPIN