Healthcare Provider Details

I. General information

NPI: 1124356050
Provider Name (Legal Business Name): SYNERGY SPINE AND JOINT CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2009
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 PLEASANT HOME RD SUITE D-1
AUGUSTA GA
30907-0518
US

IV. Provider business mailing address

211 PLEASANT HOME RD SUITE D-1
AUGUSTA GA
30907-0518
US

V. Phone/Fax

Practice location:
  • Phone: 706-364-3940
  • Fax: 706-364-3960
Mailing address:
  • Phone: 706-364-3940
  • Fax: 706-364-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR007940
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number038689
License Number StateGA

VIII. Authorized Official

Name: DR. JOHN CHERNI
Title or Position: CEO
Credential: D.C.
Phone: 706-364-3940