Organization
SPINE CENTER ATLANTA SOUTH, LLC
Active
Other names
Spine Center Riverdale, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN WEIDLER (CHIEF OPERATING OFFICER)
(404) 351-5812
Entity
Organization
Contact information
Practice address
102 VINCENT AVE., STOCKBRIDGE, GA 30281-5049
(678) 974-0158
(678) 608-3217
Mailing address
3161 HOWELL MILL RD NW, STE 310, ATLANTA, GA 30327-2132
(404) 351-5812
(678) 608-3217
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
208100000X
Physical Medicine & Rehabilitation Physician
063309
GA
208VP0000X
Pain Medicine Physician
—
—
Other
Enumeration date
04/25/2017
Last updated
12/14/2018
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