1528717378 NPI number — POLARIS SPINE & NEUROSURGERY CENTER PC

Table of content: (NPI 1528717378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528717378 NPI number — POLARIS SPINE & NEUROSURGERY CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POLARIS SPINE & NEUROSURGERY CENTER 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:
1528717378
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1150 HAMMOND DR STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30328-8617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
140-425-6263
Provider Business Mailing Address Fax Number:
404-255-6532

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1903 PHOENIX BLVD STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLLEGE PARK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30349-5700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-777-1127
Provider Business Practice Location Address Fax Number:
404-255-6532
Provider Enumeration Date:
03/21/2022

Additional Information

Authorized Official

Authorized Official Last Name:
STEUER
Authorized Official First Name:
MAX
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DOCTOR/OWNER
Authorized Official Telephone Number:
608-957-3025

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com