# SPINE SPECIALISTS OF ATLANTA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114417250
- **Authorized official:** MR. DANA GENE PICCIRILLO (OWNER)
- **Authorized official phone:** (770) 934-4233

## Contact information

- **Practice address:** 1462 MONTREAL RD. SUITE 212, TUCKER, GA 30084-6929
- **Practice address phone:** (770) 934-4233
- **Practice address fax:** (678) 395-4585
- **Mailing address:** 1462 MONTREAL RD. SUITE 212, TUCKER, GA 30084-6929
- **Mailing address phone:** (770) 934-4233
- **Mailing address fax:** (678) 395-4585

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 79267 | GA | Yes |

## Other

- **Enumeration date:** 05/15/2018
- **Last updated:** 05/15/2018