# AIRPORT SPINAL INJURY

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

## Provider details

- **NPI number:** 1699193987
- **Authorized official:** DETRICIA JOHNSON (MANAGER)
- **Authorized official phone:** (404) 761-2855

## Contact information

- **Practice address:** 809 NORTH CENTRAL AVE, HAPEVILLE, GA 30354
- **Practice address phone:** (404) 761-2855
- **Mailing address:** 809 NORTH CENTRAL AVE, HAPEVILLE, GA 30354
- **Mailing address phone:** (404) 761-2855

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 2247 | GA | Yes |

## Other

- **Enumeration date:** 04/03/2014
- **Last updated:** 04/03/2014