Healthcare Provider Details

I. General information

NPI: 1316384357
Provider Name (Legal Business Name): GBS NEUROSPINE SURGICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 05/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 FM 1960 BYPASS RD E
HUMBLE TX
77338-3909
US

IV. Provider business mailing address

11877 DOUGLAS RD # 102-272
ALPHARETTA GA
30005-4325
US

V. Phone/Fax

Practice location:
  • Phone: 281-964-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: ELIAS DAGNEW
Title or Position: MANAGING MEMBER
Credential:
Phone: 713-532-7311