MEDICARE: LIFE ORTHOPAEDIC & SPINE CENTER

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	174400000X	Specialist	0620697	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922337120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE ORTHOPAEDIC & SPINE CENTER

Provider Business Mailing Address
First Line	:	6584 PROFESSIONAL PL
Second Line	:	SUITE A
City	:	RIVERDALE
State	:	GA
Zip	:	30274-4942
Country	:	US
Telephone Number	:	770-477-1115
Fax Number	:	770-477-1119

Provider Business Practice Location Address
First Line	:	6584 PROFESSIONAL PL
Second Line	:	SUITE A
City	:	RIVERDALE
State	:	GA
Zip	:	30274-4942
Country	:	US
Telephone Number	:	770-477-1115
Fax Number	:	770-477-1119

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DASHAWN BAKARI
Credential	:	M.D.
Telephone Number	:	770-477-1115

Provider Enumeration Date	:	12/17/2009
Last Update Date	:	05/04/2016

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Directions to “LIFE ORTHOPAEDIC & SPINE CENTER ” Practice Location

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