Provider Demographics
NPI:1992496517
Name:LEGACY CENTER FOR SPINAL SURGERY- RIVERDALE LLC
Entity type:Organization
Organization Name:LEGACY CENTER FOR SPINAL SURGERY- RIVERDALE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
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:770-291-8987
Mailing Address - Fax:
Practice Address - Street 1:528 VALLEY HILL RD SW STE C
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2441
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:2023-05-16
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty