Provider Demographics
NPI:1831358787
Name:SOUTH ATLANTA SPINE AND WELLNESS CENTER
Entity type:Organization
Organization Name:SOUTH ATLANTA SPINE AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-943-2697
Mailing Address - Street 1:1711 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-4115
Mailing Address - Country:US
Mailing Address - Phone:404-767-7474
Mailing Address - Fax:
Practice Address - Street 1:1711 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-4115
Practice Address - Country:US
Practice Address - Phone:404-767-7474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty