# BUCKHEAD SPINE SPECIALIST LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** GWINNETT SPINE SPECIALISTS LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1700522059
- **Legal business name:** GWINNETT SPINE SPECIALISTS LLC
- **Authorized official:** DAFNE SCHENENDORF (CFO)
- **Authorized official phone:** (678) 687-6805

## Contact information

- **Practice address:** 2690 BUFORD HWY NE STE 200, ATLANTA, GA 30324-5453
- **Practice address phone:** (404) 869-6400
- **Practice address fax:** (470) 299-6558
- **Mailing address:** 2690 BUFORD HWY NE STE 200, ATLANTA, GA 30324-5453
- **Mailing address phone:** (404) 869-6400
- **Mailing address fax:** (470) 299-6558

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111NR0400X | Rehabilitation Chiropractor | — | NULL | — |
| 111NR0400X | Rehabilitation Chiropractor | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |
| 225200000X | Physical Therapy Assistant | — | NULL | — |
| 225200000X | Physical Therapy Assistant | — | — | — |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | — |
| 261QR0400X | Rehabilitation Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 05/10/2022
- **Last updated:** 10/31/2023