Healthcare Provider Details

I. General information

NPI: 1386514537
Provider Name (Legal Business Name): NOVA BRAIN AND SPINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2025
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MANASSAS ST STE 300
HAMPTON GA
30228-5906
US

IV. Provider business mailing address

700 MANASSAS ST STE 300
HAMPTON GA
30228-5906
US

V. Phone/Fax

Practice location:
  • Phone: 770-515-8770
  • Fax: 404-891-8323
Mailing address:
  • Phone: 770-515-8770
  • Fax: 404-891-8323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JERRY LEE WALTERS II
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 601-842-1054