# SPINE CENTER ATLANTA EAST, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Spine Center Conyers,LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194274001
- **Authorized official:** STEVEN WEIDLER (CHIEF OPERATING OFFICER)
- **Authorized official phone:** (404) 351-5812

## Contact information

- **Practice address:** 1309 WELLBROOK CIR., STE H, CONYERS, GA 30012-3873
- **Practice address phone:** (678) 263-2020
- **Practice address fax:** (678) 608-3217
- **Mailing address:** 3161 HOWELL MILL RD NW, STE 310, ATLANTA, GA 30327-2132
- **Mailing address phone:** (404) 351-5812
- **Mailing address fax:** (678) 608-3217

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | Yes |
| 208VP0000X | Pain Medicine Physician | — | NULL | — |
| 208VP0000X | Pain Medicine Physician | — | — | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | NULL | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 10/04/2016
- **Last updated:** 12/14/2018