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General NPI Number Information
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NPI Number | 1801320510
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Entity Type | Organization
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Legal Business Name | JOHNS CREEK CENTER FOR PAIN AND SPINE
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Dates
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Enumeration Date | 04/19/2017
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Last Update Date | 08/25/2017
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Provider Practice Location Address
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Address Line | 6300 HOSPITAL PKWY SUITE 425
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City | JOHNS CREEK
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State | GA
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Zip | 30097-1828
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Country | US
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Telephone | 770-771-6580
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Fax |
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Provider Business Mailing Address
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Address Line | 1365 ROCK QUARRY RD SUITE 202
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-5029
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Country | US
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Telephone | 770-771-6580
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Fax |
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Authorized Official
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Title or Position | COO
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Name | LINDSEY ANN MATHES
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Credential |
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Telephone | 770-771-6582
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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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