MEDICARE: GEORGIA SPINE SURGERY CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1407169212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGIA SPINE SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	1061 DOWDY RD
Second Line	:	SUITE 103
City	:	ATHENS
State	:	GA
Zip	:	30606-5700
Country	:	US
Telephone Number	:	706-543-9222
Fax Number	:	706-543-9230

Provider Business Practice Location Address
First Line	:	1061 DOWDY RD
Second Line	:	SUITE 103
City	:	ATHENS
State	:	GA
Zip	:	30606-5700
Country	:	US
Telephone Number	:	513-561-8900
Fax Number	:	513-561-8901

Authorized Official
Title or Position	:	OFFICER/AO
Name	:	MR. COLLIN LEMAISTRE
Credential	:
Telephone Number	:	214-213-0732

Provider Enumeration Date	:	07/21/2010
Last Update Date	:	10/07/2024

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