Organization
SOUTH GA SPINE CARE INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW GREGORY CORDISTA MD (DOCTOR)
(229) 890-6612
Entity
Organization
Contact information
Practice address
8 LIVE OAK CT, MOULTRIE, GA 31768-6783
(229) 890-6612
(229) 890-6621
Mailing address
8 LIVE OAK CT, MOULTRIE, GA 31768-6783
(229) 890-6612
(229) 890-6621
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
051451
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000921522B
—
GA
Enumeration date
02/07/2007
Last updated
12/16/2015
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