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NPI Code Detail

MEDICARE: SPINE CIN OF ATLANTA LLC

MEDICARE: SPINE CIN OF ATLANTA LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207XS0117XOrthopaedic Surgery of the Spine PhysicianGA
2207X00000XOrthopaedic Surgery PhysicianGA

General Provider Information

NPI Number : 1184122962
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPINE CIN OF ATLANTA LLC
Provider Business Mailing Address
First Line : 102 WOODMONT BLVD STE 350
Second Line :
City : NASHVILLE
State : TN
Zip : 37205-2216
Country : US
Telephone Number : 615-386-0064
Fax Number : 615-386-0067
Provider Business Practice Location Address
First Line : 10 GLENLAKE PKWY STE 130A
Second Line :
City : ATLANTA
State : GA
Zip : 30328-3495
Country : US
Telephone Number : 615-386-0064
Fax Number : 615-386-0067
Authorized Official
Title or Position : DIRECTOR
Name : EDWARD LELAND HUTTON EADIE
Credential :
Telephone Number : 615-733-2064
Provider Enumeration Date : 01/26/2018
Last Update Date : 01/26/2018

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Directions to “SPINE CIN OF ATLANTA LLC ” Practice Location

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