MEDICARE: NOVA BRAIN AND SPINE, 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
1	207T00000X	Neurological Surgery Physician

General Provider Information

NPI Number	:	1386514537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA BRAIN AND SPINE, LLC

Provider Business Mailing Address
First Line	:	700 MANASSAS ST STE 300
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-5906
Country	:	US
Telephone Number	:	770-515-8770
Fax Number	:	404-891-8323

Provider Business Practice Location Address
First Line	:	700 MANASSAS ST STE 300
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-5906
Country	:	US
Telephone Number	:	770-515-8770
Fax Number	:	404-891-8323

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	DR. JERRY LEE WALTERS II
Credential	:	MD
Telephone Number	:	601-842-1054

Provider Enumeration Date	:	11/11/2025
Last Update Date	:	04/23/2026

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