Provider Demographics
NPI:1649371907
Name:THE BRAIN AND SPINE CENTER OF SOUTHEAST GA
Entity type:Organization
Organization Name:THE BRAIN AND SPINE CENTER OF SOUTHEAST GA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-262-6552
Mailing Address - Street 1:1111 GLYNCO PKWY
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-7921
Mailing Address - Country:US
Mailing Address - Phone:912-262-6552
Mailing Address - Fax:
Practice Address - Street 1:1111 GLYNCO PKWY
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-7921
Practice Address - Country:US
Practice Address - Phone:912-262-6552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty