Healthcare Provider Details

I. General information

NPI: 1265802318
Provider Name (Legal Business Name): SPINE AND ORTHOPEDICS OF ATLANTA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1462 MONTREAL RD STE 218
TUCKER GA
30084
US

IV. Provider business mailing address

1462 MONTREAL RD STE 218
TUCKER GA
30084-6931
US

V. Phone/Fax

Practice location:
  • Phone: 470-294-0863
  • Fax: 470-294-0889
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DAMIEN DOUTE
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 470-440-5848