Healthcare Provider Details

I. General information

NPI: 1962999847
Provider Name (Legal Business Name): ATLANTA SPINE SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 02/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 PEACHTREE PARK DR NE STE 200
ATLANTA GA
30309-1304
US

IV. Provider business mailing address

1288A WELLBROOK CIRCLE
CONYERS GA
30012-8032
US

V. Phone/Fax

Practice location:
  • Phone: 678-369-6934
  • Fax:
Mailing address:
  • Phone: 678-369-6934
  • Fax: 770-679-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: HARVINDER BHATTI
Title or Position: OWNER
Credential: M.D.
Phone: 678-369-6934