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General NPI Number Information
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NPI Number | 1225916364
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Entity Type | Organization
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Legal Business Name | SOUTHLAND SPINE AND JOINT LLC
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Dates
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Enumeration Date | 08/26/2025
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 71 W CANDLER ST
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City | WINDER
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State | GA
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Zip | 30680-2503
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Country | US
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Telephone | 762-356-5416
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Fax |
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Provider Business Mailing Address
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Address Line | 2425 W BROAD ST
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City | ATHENS
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State | GA
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Zip | 30606-3415
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Country | US
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Telephone | 706-224-8599
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DOUGLAS L GILES
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Credential | DC
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Telephone | 706-224-8599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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