Provider Demographics
NPI:1881813624
Name:ATLANTA SPINE CENTER PC
Entity type:Organization
Organization Name:ATLANTA SPINE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:YARNS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-575-1300
Mailing Address - Street 1:1720 PEACHTREE ST NW
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2449
Mailing Address - Country:US
Mailing Address - Phone:404-575-1300
Mailing Address - Fax:404-575-1301
Practice Address - Street 1:1720 PEACHTREE ST NW
Practice Address - Street 2:SUITE 140
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2449
Practice Address - Country:US
Practice Address - Phone:404-575-1300
Practice Address - Fax:404-575-1301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005614111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1639124001OtherNPI #
GA202G701473Medicare PIN
GA35ZCJSFMedicare PIN