MEDICARE: SOUTHEAST BRAIN AND SPINE PC

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	:	1699194712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST BRAIN AND SPINE PC

Provider Business Mailing Address
First Line	:	1538 13TH AVE STE B300
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-2563
Country	:	US
Telephone Number	:	706-243-0020
Fax Number	:

Provider Business Practice Location Address
First Line	:	1538 13TH AVE STE B300
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-2563
Country	:	US
Telephone Number	:	706-243-0020
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARC GOLDMAN
Credential	:	MD
Telephone Number	:	706-321-9300

Provider Enumeration Date	:	04/16/2014
Last Update Date	:	05/22/2024

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Directions to “SOUTHEAST BRAIN AND SPINE PC ” Practice Location

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