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General NPI Number Information
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NPI Number | 1669916060
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Entity Type | Organization
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Legal Business Name | ADVANCED NEUROSPINE SURGERY CENTER, LLC
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Dates
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Enumeration Date | 12/05/2016
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Last Update Date | 12/05/2016
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Provider Practice Location Address
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Address Line | 9635 VENTANA WAY SUITE 202
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City | JOHNS CREEK
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State | GA
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Zip | 30022-8620
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Country | US
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Telephone | 404-446-4424
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Fax | 404-446-4420
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Provider Business Mailing Address
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Address Line | 9635 VENTANA WAY SUITE 202
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City | JOHNS CREEK
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State | GA
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Zip | 30022-8620
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Country | US
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Telephone | 404-446-4424
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Fax | 404-446-4420
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELIAS DAGNEW
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Credential | MD FAANS
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Telephone | 404-446-4424
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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 | ME96941
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License Number State | GA
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