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General NPI Number Information
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NPI Number | 1780576033
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Entity Type | Organization
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Legal Business Name | SUMMIT SPINE ASSOCIATES PA
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Dates
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Enumeration Date | 07/18/2025
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 4415 US HIGHWAY 331 S STE 300
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City | DEFUNIAK SPRINGS
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State | FL
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Zip | 32435-6307
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Country | US
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Telephone | 404-922-3764
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Fax |
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Provider Business Mailing Address
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Address Line | 3280 POINTE PKWY
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City | PEACHTREE COR
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State | GA
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Zip | 30092-3343
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Country | US
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Telephone | 404-922-3764
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MIGUEL JIMENEZ
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Credential | MD
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Telephone | 404-922-3764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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