Healthcare Provider Details

I. General information

NPI: 1093586851
Provider Name (Legal Business Name): THE CENTER FOR SPINE PROCEDURES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/11/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SIGMAN RD NE STE 120
CONYERS GA
30012-3819
US

IV. Provider business mailing address

335 ROSELANE ST NW
MARIETTA GA
30060-7902
US

V. Phone/Fax

Practice location:
  • Phone: 770-760-9360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY GRASSO
Title or Position: OWNER
Credential:
Phone: 770-421-1420