MEDICARE: ATLANTA BRAIN AND SPINE CARE, P.C.

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	089949 LGB	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DA7904	OTHER		RAILROAD MEDICARE

General Provider Information

NPI Number	:	1659376275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTA BRAIN AND SPINE CARE, P.C.

Provider Business Mailing Address
First Line	:	2001 PEACHTREE RD NE STE 575
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-1476
Country	:	US
Telephone Number	:	404-350-0106
Fax Number	:	404-350-0176

Provider Business Practice Location Address
First Line	:	2001 PEACHTREE RD NE STE 575
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-1476
Country	:	US
Telephone Number	:	404-350-0106
Fax Number	:	404-350-0176

Authorized Official
Title or Position	:	SECRETARY / TREASURER
Name	:	REGIS WILLIAM HAID JR.
Credential	:	M.D.
Telephone Number	:	404-350-0106

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	02/10/2012

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Directions to “ATLANTA BRAIN AND SPINE CARE, P.C. ” Practice Location

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