SPINE CENTER ATLANTA EAST, LLC


Address: 1309 Wellbrook Cir., Ste H, Conyers, GA 30012-3873
Phone: 6782632020

SPINE CENTER ATLANTA EAST, LLC (NPI# 1194274001) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1194274001
Entity Type Organization
Organization Name SPINE CENTER ATLANTA EAST, LLC
Other Organization Name SPINE CENTER CONYERS,LLC
Practice Address 1309 Wellbrook Cir.
Ste H
Conyers
GA 30012-3873
Mailing Address 3161 Howell Mill Rd Nw
Ste 310
Atlanta
GA 30327-2132
Practice Telephone 6782632020
Practice Fax Number 6786083217
Mailing Telephone 4043515812
Mailing Fax Number 6786083217
Enumeration Date 2016-10-04
Last Update Date 2018-12-14
Authorized Official Name STEVEN WEIDLER (CHIEF OPERATING OFFICER)
Authorized Official Telephone 4043515812
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 208VP0000X Pain Medicine
Specialization: Pain Medicine
Allopathic & Osteopathic Physicians
N 208VP0014X Pain Medicine
Specialization: Interventional Pain Medicine
Allopathic & Osteopathic Physicians
Y 2081P2900X Physical Medicine & Rehabilitation
Specialization: Pain Medicine
Allopathic & Osteopathic Physicians

Other Provider/Organization Names

Other Name Type Code
Spine Center Conyers,LLC Former Legal Business Name - Organization

Office Location

Street Address 1309 WELLBROOK CIR.
STE H
City CONYERS
State GA
Zip Code 30012-3873

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1578188306 The Eye Md Ophthalmology 1359 Milstead Road, Suite #103, Conyers, GA 30012 2020-06-08
1043855836 Maurvet Minto Counselor 1175 Green St, Conyers, Conyers, GA 30012 2019-11-15
1770054561 Sarah Elizabeth Brooks Physical Medicine & Rehabilitation 1290 Milstead Ave Ne, Conyers, GA 30012 2018-12-06
1679091276 Valorie Antoinette Jones Counselor 1175 Green St Se, Conyers, GA 30012 2017-09-02
1558886341 Synergy Radiology, LLC Radiology 1501 Milstead Road, Suite 140, Conyers, GA 30012 2017-08-14
1558813295 Salon Lyon, LLC Specialist 1112 West Ave, Se, B, Conyers, GA 30012 2016-10-28
1992252753 Traci Hunter Bryan Pharmacist 1501 Milstead Ave Ne, Suite 110, Conyers, GA 30012 2016-09-08
1316491830 Hye Rim Kim Anesthesiologist Assistant 1380 Milstead Rd Ne, Suite G, Conyers, GA 30012 2016-08-12
1235591397 David Jeffrey Wasserman Optometrist 1192 Dogwood Dr Sw, Conyers, GA 30012 2016-03-28
1174919187 Anique Archer Health Educator 2170 Lester Rd Nw, Conyers, GA 30012 2015-04-07
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Taxonomy Information

Taxonomy Code 2081P2900X
Grouping Allopathic & Osteopathic Physicians
Classification Physical Medicine & Rehabilitation
Specialization Pain Medicine

Taxonomy Definition

A physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source changed] Additional Resources: American Board of Physical Medicine and Rehabilitation, 2007. http://www.abpmr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Physical Medicine and Rehabilitation. A subspecialty certificate was approved by the ABMS in 1999. ACGME Accredited Residency Program Requirements: Proposal under development.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1073979621 Atlanta Spine, PC Physical Medicine & Rehabilitation 1288 Wellbrook Cir Ne Ste A, Conyers, GA 30012-8032 2016-01-12

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1700490091 Interventional and Alternative Spine and Wellness, LLC Physical Medicine & Rehabilitation 3630 Wheeler Rd, Augusta, GA 30909-6561 2020-09-03
1881205151 Georgia Regenrx, LLC. Physical Medicine & Rehabilitation 5755 N Point Pkwy Ste 72, Alpharetta, GA 30022-1146 2020-08-11
1710514989 Jennifer Meyer Physical Medicine & Rehabilitation 1554 Riverstone Pkwy Ste 160, Canton, GA 30114-2887 2020-03-26
1982172060 Back To Life Pain Center, LLC Physical Medicine & Rehabilitation 410 Creekstone Rdg, Woodstock, GA 30188-3740 2018-11-07
1760900708 Neuro Diagnostic Group LLC Physical Medicine & Rehabilitation 200 Galleria Pkwy Se Ste 100, Atlanta, GA 30339-5944 2017-08-30
1386195378 Pain Management and Rehabilitation Physical Medicine & Rehabilitation 4121 Steve Reynolds Blvd, Norcross, GA 30093-3060 2016-10-14
1124471172 Pain Management and Rehabilitation Physical Medicine & Rehabilitation 4131 Steve Reynolds Blvd, Norcross, GA 30093-3060 2016-07-14
1043671761 Pain Management and Rehabilitation Inc Physical Medicine & Rehabilitation 3955 Lawrenceville Hwy Nw, Lilburn, GA 30047-2996 2016-03-08
1356761191 Simon Matt Willis Physical Medicine & Rehabilitation 114 Canal St Ste 503, Pooler, GA 31322-4261 2014-04-20
1891139663 Advanced Pain and Rahabilitation PC Physical Medicine & Rehabilitation 3030 Mcever Rd Ste 300, Gainesville, GA 30504-5538 2013-04-24
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Competitor

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City CONYERS
Zip Code 30012

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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