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General NPI Number Information
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NPI Number | 1700522059
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Entity Type | Organization
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Legal Business Name | BUCKHEAD SPINE SPECIALIST LLC
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Dates
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Enumeration Date | 05/10/2022
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Last Update Date | 10/31/2023
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Provider Practice Location Address
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Address Line | 2690 BUFORD HWY NE STE 200
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City | ATLANTA
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State | GA
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Zip | 30324-5453
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Country | US
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Telephone | 404-869-6400
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Fax | 470-299-6558
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Provider Business Mailing Address
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Address Line | 2690 BUFORD HWY NE STE 200
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City | ATLANTA
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State | GA
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Zip | 30324-5453
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Country | US
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Telephone | 404-869-6400
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Fax | 470-299-6558
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Authorized Official
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Title or Position | CFO
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Name | DAFNE SCHENENDORF
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Credential |
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Telephone | 678-687-6805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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