Healthcare Provider Details

I. General information

NPI: 1205139607
Provider Name (Legal Business Name): GEORGIA INJURY & SPINE CENTER OF ATLANTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 NORTH AVE NE
ATLANTA GA
30308-2328
US

IV. Provider business mailing address

147 NORTH AVE NE
ATLANTA GA
30308-2328
US

V. Phone/Fax

Practice location:
  • Phone: 404-892-1004
  • Fax:
Mailing address:
  • Phone: 404-892-1004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number005833
License Number StateGA

VIII. Authorized Official

Name: DR. BRIAN D VEAL
Title or Position: DIRECTOR
Credential: DC
Phone: 404-379-7093