MEDICARE: STAR ORTHOPEDICS AND SPINE OF ATLANTA

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	:	1568158327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAR ORTHOPEDICS AND SPINE OF ATLANTA

Provider Business Mailing Address
First Line	:	1720 PHOENIX BLVD STE 800
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-5596
Country	:	US
Telephone Number	:	404-348-2750
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 PHOENIX BLVD STE 800
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-5596
Country	:	US
Telephone Number	:	404-348-2750
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	HILLARY KOERNER
Credential	:
Telephone Number	:	561-908-3200

Provider Enumeration Date	:	04/14/2023
Last Update Date	:	04/14/2023

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