Provider Demographics
NPI:1700522059
Name:BUCKHEAD SPINE SPECIALIST LLC
Entity Type:Organization
Organization Name:BUCKHEAD SPINE SPECIALIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAFNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHENENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-687-6805
Mailing Address - Street 1:2690 BUFORD HWY NE STE 200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-5453
Mailing Address - Country:US
Mailing Address - Phone:404-869-6400
Mailing Address - Fax:470-299-6558
Practice Address - Street 1:2690 BUFORD HWY NE STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-5453
Practice Address - Country:US
Practice Address - Phone:404-869-6400
Practice Address - Fax:470-299-6558
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GWINNETT SPINE SPECIALISTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-10
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty