1912738386 NPI number — LASER SPINE SURGERY CENTER, LLC

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 1912738386 NPI number — LASER SPINE SURGERY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LASER SPINE SURGERY CENTER, LLC
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:
1912738386
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1944 CLAIRMONT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30033-3406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-997-0600
Provider Business Mailing Address Fax Number:
678-565-3625

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2080 CENTURY PARK E
Provider Second Line Business Practice Location Address:
STE 606
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90067-2029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-677-0000
Provider Business Practice Location Address Fax Number:
678-565-3625
Provider Enumeration Date:
08/08/2024

Additional Information

Authorized Official

Authorized Official Last Name:
REZAIAMIRI
Authorized Official First Name:
SHAHRAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
770-997-0600

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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