# ATLANTIC SPORT & SPINE CENTER

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

## Provider details

- **NPI number:** 1316388978
- **Authorized official:** MICHAEL G SANDBORN MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (386) 445-9444

## Contact information

- **Practice address:** 3 BOULDER ROCK DR, PALM COAST, FL 32137-8555
- **Practice address phone:** (386) 445-9444
- **Practice address fax:** (386) 446-2971
- **Mailing address:** 3 BOULDER ROCK DR, PALM COAST, FL 32137-8555
- **Mailing address phone:** (386) 445-9444
- **Mailing address fax:** (386) 446-2971

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | HCC9168 | FL | Yes |

## Other

- **Enumeration date:** 07/11/2013
- **Last updated:** 07/11/2013