Organization
COLUMBUS SPINE AND PERFORMANCE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GORDON LESLIE STEPHENSON JR. D.C. (SHAREHOLDER)
(706) 596-0909
Entity
Organization
Contact information
Practice address
1714 MANCHESTER EXPY, COLUMBUS, GA 31904-6748
(706) 596-0909
(706) 596-0919
Mailing address
1714 MANCHESTER EXPY, COLUMBUS, GA 31904-6748
(706) 596-0909
(706) 596-0919
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
GA005828
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GRP4198
MEDICAGE GROUP NUMBER
—
Enumeration date
05/15/2008
Last updated
05/15/2008
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