Provider Demographics
NPI:1437407525
Name:CENTER FOR SPINE INTERVENTIONS, PC
Entity type:Organization
Organization Name:CENTER FOR SPINE INTERVENTIONS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-813-2741
Mailing Address - Street 1:2713 CHARLES HARDY PKWY STE 212
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-9445
Mailing Address - Country:US
Mailing Address - Phone:678-813-2741
Mailing Address - Fax:
Practice Address - Street 1:2713 CHARLES HARDY PKWY STE 222
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-9470
Practice Address - Country:US
Practice Address - Phone:678-813-2741
Practice Address - Fax:678-813-2740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-21
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty