Provider Demographics
NPI:1407605116
Name:LEGACY BRAIN & SPINE LLC
Entity type:Organization
Organization Name:LEGACY BRAIN & SPINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAID
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSHIHABI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-291-8987
Mailing Address - Street 1:1900 THE EXCHANGE SE STE 200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1900 THE EXCHANGE SE STE 600
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2050
Practice Address - Country:US
Practice Address - Phone:770-291-8987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-15
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty