Provider Demographics
NPI:1972922607
Name:NORTH COBB SPINE AND NERVE INSTITUTE, LLC
Entity type:Organization
Organization Name:NORTH COBB SPINE AND NERVE INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-874-5678
Mailing Address - Street 1:3451 COBB PKWY NW
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-5766
Mailing Address - Country:US
Mailing Address - Phone:678-574-5678
Mailing Address - Fax:678-574-5605
Practice Address - Street 1:3451 COBB PKWY NW
Practice Address - Street 2:SUITE 4
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-5766
Practice Address - Country:US
Practice Address - Phone:678-574-5678
Practice Address - Fax:678-574-5605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA7129980001Medicare NSC