Provider Demographics
NPI:1366181778
Name:AXION SPINE OUTPATIENT SURGERY CENTER
Entity type:Organization
Organization Name:AXION SPINE OUTPATIENT SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-579-3962
Mailing Address - Street 1:PO BOX 2839
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-0048
Mailing Address - Country:US
Mailing Address - Phone:470-579-3962
Mailing Address - Fax:470-579-3961
Practice Address - Street 1:4100 OLD MILTON PKWY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4442
Practice Address - Country:US
Practice Address - Phone:470-579-3962
Practice Address - Fax:470-579-3961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-02
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical