Healthcare Provider Details

I. General information

NPI: 1215826557
Provider Name (Legal Business Name): KOJINMO SPINE CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1295 OLD PEACHTREE RD NW STE 270
SUWANEE GA
30024-2770
US

IV. Provider business mailing address

1295 OLD PEACHTREE RD NW STE 270
SUWANEE GA
30024-2770
US

V. Phone/Fax

Practice location:
  • Phone: 404-932-9770
  • Fax: 678-261-1680
Mailing address:
  • Phone: 404-932-9770
  • Fax: 678-261-1680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: JIN M KO
Title or Position: CEO
Credential:
Phone: 404-932-9770