Healthcare Provider Details

I. General information

NPI: 1972828473
Provider Name (Legal Business Name): BENDER ORTHOPAEDICS & SPINE SPECIALIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HOSPITAL BLVD SUITE 150
ROSWELL GA
30076-4907
US

IV. Provider business mailing address

2500 HOSPITAL BLVD SUITE 150
ROSWELL GA
30076-4907
US

V. Phone/Fax

Practice location:
  • Phone: 678-297-7588
  • Fax: 678-297-7587
Mailing address:
  • Phone: 678-297-7588
  • Fax: 678-297-7587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number049787
License Number StateGA

VIII. Authorized Official

Name: DR. JAY B BENDER
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 678-297-7588