Provider Demographics
NPI:1114758588
Name:LASER SPINE CENTER, LLC
Entity type:Organization
Organization Name:LASER SPINE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAHRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:REZAIAMIRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-997-0600
Mailing Address - Street 1:1944 CLAIRMONT RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3406
Mailing Address - Country:US
Mailing Address - Phone:770-997-0600
Mailing Address - Fax:678-565-3625
Practice Address - Street 1:2080 CENTURY PARK E STE 500
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2008
Practice Address - Country:US
Practice Address - Phone:770-997-0600
Practice Address - Fax:678-565-3625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty