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General NPI Number Information
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NPI Number | 1194078287
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Entity Type | Organization
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Legal Business Name | NORTH REGIONAL SPINE, CORPORATION
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Dates
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Enumeration Date | 10/26/2012
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Last Update Date | 10/26/2012
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Provider Practice Location Address
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Address Line | 314 N BROAD ST SUITE 340
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City | WINDER
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State | GA
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Zip | 30680-2191
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Country | US
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Telephone | 678-661-3196
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Fax | 678-661-3196
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Provider Business Mailing Address
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Address Line | 3390 PEACHTREE RD NE SUITE 450
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City | ATLANTA
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State | GA
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Zip | 30326-1157
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Country | US
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Telephone | 770-374-3714
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Fax | 770-438-1477
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Authorized Official
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Title or Position | CEO
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Name | MR. MIGUEL ALEXANDER JIMENEZ
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Credential | M.D.
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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 | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 052966
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License Number State | GA
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