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General NPI Number Information
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NPI Number | 1134700743
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Entity Type | Organization
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Legal Business Name | OHANA SPINE & ORTHO CARE
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Dates
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Enumeration Date | 04/15/2021
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Last Update Date | 04/29/2021
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Provider Practice Location Address
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Address Line | 412 US HIGHWAY 80 SW
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City | POOLER
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State | GA
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Zip | 31322-2541
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Country | US
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Telephone | 912-509-2892
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Fax | 912-295-2678
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Provider Business Mailing Address
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Address Line | 501 DRESLER RD
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City | RINCON
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State | GA
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Zip | 31326-4749
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Country | US
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Telephone | 912-509-2892
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Fax | 912-295-2678
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Authorized Official
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Title or Position | CEO
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Name | DANIELLE GILKEY
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Credential |
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Telephone | 912-509-2892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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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 | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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