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General NPI Number Information
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NPI Number | 1053719393
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Entity Type | Organization
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Legal Business Name | PCA INTERVENTIONAL SPINE AT MACQUARIUM
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Dates
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Enumeration Date | 12/19/2014
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 1800 PEACHTREE ST NW SUITE 775
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City | ATLANTA
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State | GA
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Zip | 30309-2519
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Country | US
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Telephone | 404-351-7654
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Fax | 770-692-6082
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Provider Business Mailing Address
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Address Line | PO BOX 40166
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City | BELFAST
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State | ME
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Zip | 04915-1241
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Country | US
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Telephone | 888-488-8289
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Fax | 502-919-9780
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Authorized Official
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Title or Position | OWNER/MEDICAL DIRECTOR
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Name | RODRIGO DURALDE
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Credential | M.D.
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Telephone | 404-351-7654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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