Provider Demographics
NPI:1194108134
Name:ATLANTA NEUROSPINE INSTITUTE, PC
Entity type:Organization
Organization Name:ATLANTA NEUROSPINE INSTITUTE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:VAID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-489-5414
Mailing Address - Street 1:6000 SHAKERAG HL
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-6523
Mailing Address - Country:US
Mailing Address - Phone:678-489-5414
Mailing Address - Fax:678-489-5537
Practice Address - Street 1:6000 SHAKERAG HL
Practice Address - Street 2:SUITE 110
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-6523
Practice Address - Country:US
Practice Address - Phone:678-489-5414
Practice Address - Fax:678-489-5537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-08
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA660952084P2900X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty