Healthcare Provider Details

I. General information

NPI: 1457081226
Provider Name (Legal Business Name): DECATUR SPINE & JOINT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3755 MEMORIAL DR
DECATUR GA
30032-2459
US

IV. Provider business mailing address

PO BOX 1601
PHENIX CITY AL
36868-1601
US

V. Phone/Fax

Practice location:
  • Phone: 470-870-9300
  • Fax: 404-393-8885
Mailing address:
  • Phone: 334-298-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN BERNARD COOPER
Title or Position: MEMBER
Credential: DC
Phone: 877-495-7773