Healthcare Provider Details

I. General information

NPI: 1679098693
Provider Name (Legal Business Name): GEORGIA SPINE AND ORTHOPAEDICS ASC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11650 ALPHARETTA HWY
ROSWELL GA
30076-3805
US

IV. Provider business mailing address

11650 ALPHARETTA HWY
ROSWELL GA
30076-3805
US

V. Phone/Fax

Practice location:
  • Phone: 404-596-5670
  • Fax:
Mailing address:
  • Phone: 404-596-5670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ERIK THOR BENDIKS
Title or Position: PRESIDENT
Credential: MD
Phone: 404-596-5670