Provider Demographics
NPI:1063787570
Name:ATLANTA SPINE SPECIALISTS, LLC
Entity type:Organization
Organization Name:ATLANTA SPINE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLINGHURST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-296-5005
Mailing Address - Street 1:2801 N DECATUR RD
Mailing Address - Street 2:STE 200
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5949
Mailing Address - Country:US
Mailing Address - Phone:404-296-5005
Mailing Address - Fax:
Practice Address - Street 1:2801 N DECATUR RD
Practice Address - Street 2:STE 200
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5949
Practice Address - Country:US
Practice Address - Phone:404-296-5005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA63563207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty