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General NPI Number Information
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NPI Number | 1013206952
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Entity Type | Organization
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Legal Business Name | GEORGIA SPINE SPECIALISTS
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Dates
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Enumeration Date | 03/31/2011
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Last Update Date | 03/31/2011
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Provider Practice Location Address
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Address Line | 3903 S COBB DR SE STE 105
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City | SMYRNA
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State | GA
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Zip | 30080-8504
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Country | US
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Telephone | 678-838-6600
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Fax | 770-438-1477
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Provider Business Mailing Address
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Address Line | 11 MAYBELLE ST
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City | CARTERSVILLE
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State | GA
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Zip | 30120-3615
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Country | US
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Telephone | 770-334-2065
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Fax | 770-334-2066
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Authorized Official
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Title or Position | CEO
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Name | DR. MIGUEL A JIMENEZ
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Credential | MD
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Telephone | 770-374-3714
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 52966
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License Number State | GA
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