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General NPI Number Information
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NPI Number | 1295834976
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Entity Type | Organization
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Legal Business Name | SPECIALTY SPINE INTERVENTION CENTER
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1240 JESSE JEWELL PKWY SE STE 300
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City | GAINESVILLE
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State | GA
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Zip | 30501-3862
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Country | US
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Telephone | 770-297-7277
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Fax |
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Provider Business Mailing Address
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Address Line | 1240 JESSE JEWELL PKWY SE STE 300
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City | GAINESVILLE
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State | GA
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Zip | 30501-3862
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Country | US
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Telephone | 770-297-7277
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ANNETTE SLOAN
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Credential | RN,FACMPE,CPC
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Telephone | 770-297-7277
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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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