MEDICARE: LASER SPINE SURGERY CENTER, 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	:	1912738386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LASER SPINE SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	1944 CLAIRMONT RD
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-3406
Country	:	US
Telephone Number	:	770-997-0600
Fax Number	:	678-565-3625

Provider Business Practice Location Address
First Line	:	2080 CENTURY PARK E
Second Line	:	STE 606
City	:	LOS ANGELES
State	:	CA
Zip	:	90067-2029
Country	:	US
Telephone Number	:	310-677-0000
Fax Number	:	678-565-3625

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHAHRAM REZAIAMIRI
Credential	:	MD
Telephone Number	:	770-997-0600

Provider Enumeration Date	:	08/08/2024
Last Update Date	:	02/12/2026

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