Provider Demographics
NPI:1194287060
Name:RIVERCITY REHABILITATION AND SPINE SPECIALISTS, P.C.
Entity type:Organization
Organization Name:RIVERCITY REHABILITATION AND SPINE SPECIALISTS, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:N
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-243-7010
Mailing Address - Street 1:2300 13TH ST APT A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-2182
Mailing Address - Country:US
Mailing Address - Phone:706-243-7010
Mailing Address - Fax:706-243-7019
Practice Address - Street 1:2300 13TH ST APT A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-2182
Practice Address - Country:US
Practice Address - Phone:706-243-7010
Practice Address - Fax:706-243-7019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site