1437407525 NPI number — CENTER FOR SPINE INTERVENTIONS, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437407525 NPI number — CENTER FOR SPINE INTERVENTIONS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR SPINE INTERVENTIONS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437407525
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2713 CHARLES HARDY PKWY STE 212
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30157-9445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-813-2741
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2713 CHARLES HARDY PKWY STE 222
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30157-9470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-813-2741
Provider Business Practice Location Address Fax Number:
678-813-2740
Provider Enumeration Date:
08/21/2012

Additional Information

Authorized Official

Authorized Official Last Name:
RAYA
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
678-813-2741

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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