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General NPI Number Information
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NPI Number | 1558528190
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Entity Type | Organization
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Legal Business Name | GEORGIA SPINE SPECIALISTS
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 04/17/2009
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Provider Practice Location Address
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Address Line | 51 GORDON RD SUITE 1
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City | JASPER
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State | GA
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Zip | 30143-7105
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Country | US
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Telephone | 678-838-6600
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Fax | 770-438-1477
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Provider Business Mailing Address
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Address Line | 3903 SOUTH COBB DR SUITE 105
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City | SMYRNA
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State | GA
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Zip | 30080
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Country | US
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Telephone | 678-838-6600
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Fax | 770-438-1477
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Authorized Official
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Title or Position | PRESIDENT
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Name | MIGUEL A JIMENEZ
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Credential | MD
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Telephone | 678-838-6600
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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 | GA052966
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | GA052966
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License Number State | GA
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